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Days
BS Description E
ICD
IOS BS
CPT
PACKAGE
Price
Center
0
Quality assurance testing and radiometric survey for C-arm Equipment
900010
3,000.00
0
Quality assurance testing and radiometric survey for
900011
5,000.00
Computed Tomography Equipment
0
Quality assurance testing and radiometric survey for Dental
900012
3,000.00
Panoramic Radiography Equipment
0
Quality assurance testing and radiometric survey for Digital
900013
4,000.00
and Conventional X-Ray Equipment
0
Quality assurance testing and radiometric survey for Fluoroscopy Equipment
900014
5,000.00
0
Quality assurance testing and radiometric survey for Mommogram Equipment
900015
4,500.00
0
Quality assurance testing and radiometric survey for Portable X-ray Equipement
900016
3,000.00
0
Whirlpool whole body
760087
97022
200
0
ANTI-TETANUS
92148-00[1881]
780001
9214800
90
0
BCG VACCINE
92145-00[1881]
780002
9214500
90
0
DI TE ANATOXAL (ADULT) D/T
780003
40
0
DI TE ANATOXAL (CHILD)
780004
40
0
DI TE PER (1 DOSE)
780005
80
0
DPT
92149-00[1881]
780006
9214900
100
0
DT
780007
70
0
ENGERIX-B PEDIA (1 DOSE)
780008
90
0
GLOBUMAN BERNA 2 ML
780009
110
0
GLOBUMAN BERNA 2ML
780010
100
0
Haemophilus influenzae HIB
780011
90
0
HAVRIX VACC (HEP A)
92169-00[1883]
780012
140
0
HAVRIX VACCINE (HEP-A)
92169-00[1883]
780013
9216900
100
0
HEP.B - ADULT
92168-00[1883]
780014
9216800
100
0
HEP.B - CHILDREN
92168-00[1883]
780015
9216800
100
0
HEPUMAN BERNA 2 ML(400 UNIT)
780016
900
0
HIB
780017
90
0
Influenza
780018
100
0
M.M.R. (1 DOSE)
92156-00[1882]
780019
90
0
MEASLES (MONO)
92153-00[1882]
780020
60
0
Meningitis
780021
100
0
MMR
92156-00[1882]
780022
100
0
MORUMAN 100 I.U(ANTI MEASLES)
780023
60
0
PARUMAN 100 I.U.(ANTI PAROT.)
780024
250
0
PNEUMOCOCCAL CONJUGATE VACCINE
92165-00[1883]
780025
90
0
POLIO- 1M.INJ.
92150-00[1882]
780026
60
0
POLIO-ORAL
92150-00[1882]
780027
40
0
RHESUMAN BERNA 250 MG
780028
340
0
RUBEATEN (ANTI RUBELLA)
92155-00[1882]
780029
90
0
RUBEUMAN BERNA 5 ML 30000 UNT.
780030
410
0
TETANUM 250 I.U.(TETANUS IMMU)
780031
220
0
TETANUS TOXOID
92148-00[1881]
780032
60
0
The 3 shoot of hepatitis for IQAMA (HBV )
780033
150
0
Typhoid Fever
92144-00[1881]
780034
100
0
Typhoid Vaccine
92144-00[1881]
780035
150
0
vaccine (Rabies - snake - scorpion)
780036
100
0
VARICILLA
92157-00[1882]
780037
60
0
Yellow Fever
780038
200
0
Dosimetry personal card
900001
35
0
EXTENSION OF THE DATE OF THE SANITATION CERTIFICATE FOR EACH SHIP
900002
500
0
ISSUING A CERTIFICATE OF SANITATION FOR EACH SHIP
900003
1,000.00
0
Loss of card measuring the dose of radiation
900004
500
1
MOBILE HEAVY EQUIPMENT OPERATOR CHECK-UP
900005
Y
1,350.00
0
PERMISSION TO GRANT FREE ACCESS TO CARGO
900006
200
SHIPS
0
PERMISSION TO GRANT FREE ACCESS TO PASSENGER
900007
400
SHIPS
0
Provide TLD card to workers for maesuring the dose of radiation
900008
500
0
Quality assurance testing and radiometric survey for Angiogram Equipment
900009
5,000.00
rehabilitation conditions Per Day
0
It includes Twelve (12) sessions of speech therapy within a
760047
6,100.00
month
0
It includes Twelve (12) sessions of speech therapy within a month.
760048
6,100.00
Duration: 45-60 minutes for each session.
(The types of Rehabilitation and Nursing Services will be identified according to patient�s
0
It provides twelve (12) sessions of advanced nursing care
760049
6,700.00
(wound
0
It provides twelve (12) sessions of advanced nursing care
760050
6,700.00
)wound management, Foley�s catheter, bladder management and taking care of feeding tube) within a month.
0
K.A.F.O. Orthosis
760051
9609100
6,000.00
0
Knee Joint Replacement Surgery Program
49518-00[1518]
760052
70,000.00
0
LAPAROSCOPIC - DIAGNOSTIC OF LIVER WITH BIOPSY
760053
4,400.00
0
LAPAROSCOPIC - DIAGNOSTIC OF LIVER WITHOUT
30390-00[984]
760054
3,200.00
BIOPSY
0
Manual Massage (15 minutes)
96162-00[1908]
760055
9616200
60
0
Medical and Nursing care for non-ventilated patients Per Day
760056
220
0
Medical and Nursing care for ventilated patients Per Day
760057
2,800.00
0
Medical Shoes for Foot Amputation
760058
300
0
Medical Shoes for foot deformity
760059
300
0
Milwaukee Brace
96092-00[1870]
760060
9609200
3,500.00
0
Paraffin Wax
760061
97018
75
0
Pelvis Replacement Surgery Program
760062
73,000.00
0
Pelvis replacement surgery program (Both sides).
760063
124,000.00
0
POST NATAL EXERCISE
96129-00[1876]
760064
9612900
50
0
Recovery program (early intervention for stroke) Per Day
760065
2,800.00
0
Renting Operating Room For the first Hour
760066
3,500.00
0
Renting Operating Room For the Second hour or more
760067
2,500.00
0
REPAIR - LIVER LACERATION
30422-00[954]
760068
4,400.00
0
Shortwave
760069
97020
75
0
Shoulder surgery program.
760070
71,400.00
0
Spinal Cord Injuries, TBI, Vertebrarium, GuillanBarre ,
760071
2,800.00
Rehabilitation ventilated patients , General Rehabilitation conditions of children Per Day
0
STROKE PATIENT EXERCISE
760072
95875
100
0
Strokes , Paraplegia,Neuropathies , Patients with Heart Clots
760073
2,600.00
, Respiration , Pain Management , Developmental Delay in Children Per Day
0
Taylor Brace
96092-00[1870]
760074
9609200
800
0
THERAPUTIC EXERCISE
96129-00[1876]
760075
9612900
75
0
THERAPUTIC EXERCISE whole body
96129-00[1876]
760076
9612900
150
0
Three (3) sessions of physiotherapy or occupational therapy.Three (3) sessions of nursing care.The duration is (45- 60) minutes for each session.(Rehabilitation therapy and
760077
1,900.00
nursing services will be ide
0
Through Ankle Lower Limb Prosthesis Saymes
760078
3,000.00
0
Through Knee Lower Limb Prosthesis (Modular)
760079
8,000.00
0
Through Wrist U.L. Prosthesis (Dynamic)
760080
4,000.00
0
Through Wrist Upper Limb Prosthesis (Cosmetic)
760081
4,000.00
0
TILTING TABLE
760082
100
0
Twelve (12) sessions of physiotherapy or occupational therapy.Twelve (12) sessions of nursing care.Two (2) sessions with nutrition specialist.The duration is 45-60 minutes for each session.(The types
760083
8,000.00
0
Ultra Violet
14053-01[1609]
760084
1405301
60
0
Ultrasonic
760085
97035
75
0
Whirlpool one part
760086
100
0
Above Elbow U.L. Prostheses (Cosmetic Hand)
760002
5,000.00
0
Above Elbow U.L. Prostheses (Dynamic Hand)
760003
10035
6,000.00
0
Above Knee L.L. Prosthesis (Hydraulic)
760004
10047
20,000.00
0
Above Knee Lower Limb Prosthesis (Hydraulic w/ poly ethylene socket)
760005
10045
20,000.00
0
Above Knee Lower Limb Prosthesis (Modular)
760006
12,000.00
0
Above Knee Lower Limb Prosthesis (Wood)
760007
6,000.00
0
Adult Plastic Splint Orthoplast
96092-00[1870]
760008
9609200
600
0
Adult Plastic Splint Polypropylene
96092-00[1870]
760009
9609200
400
0
ALL BEDSIDE THERAPY
760010
100
0
ANTI-NATAL EXERCISE.
760011
50
0
Aspiration or Joint Injection
50124-01[1552]
760012
5012401
150
0
Below Elbow U.L. Prostheses (Cosmetic Hand)
760013
4,000.00
0
Below Elbow U.L. Prostheses (Dynamic Hand)
760014
4,000.00
0
Below Knee Lower Limb (Modular)
760015
5,000.00
0
Below Knee Lower Limb (Wood)
760016
5,000.00
0
Boston Brace
96092-00[1870]
760017
9609200
800
0
Both Knees Joints Replacement Surgery Program
49519-00[1518]
760018
106,400.00
0
Chest Physiotherapy
95550-03[1916]
760019
9555003
60
0
CHEST PHYSIOTHERAPY+BREATH. EX.
95550-03[1916]
760020
9555003
50
0
Children Plastic Splint Orthoplast
96092-00[1870]
760021
9609200
300
0
Children Plastic Splint Polypropylene
96092-00[1870]
760022
9609200
300
0
CHOLEDOCHOSCOPE ( INTRAOPERATIVE)
30442-00[957]
760023
3,200.00
0
CPM (CONTINUES PASSIVE MOTION)
760025
50
0
Different Medical Insole
760026
10013
50
0
Electrical Massage
96162-00[1908]
760027
9616200
50
0
Electrical Stimulation
13400-00[1890]
760028
1340000
75
0
Electrotherapy
30195-06[1612]
760029
3019506
60
0
H.K.A.F.O. Orthosis
760030
9609100
8,000.00
0
HEPATITIS B IMMUNOGLOBULIN INFUSION SESSION [ HBIG ] (INCL; DRUG PREP, CONSULT SUPERVISION,ACCOM, IVFLUIDS,SUPPLIES, NURSE
13706-05[1893]
760031
2,600.00
CARE, W/OUT MED)
0
HEPATORRHAPHY [ REPAIR OF LIVER LACERATION ]
30422-00[954]
760032
3,200.00
0
Hydrotherapy
96153-00[1880]
760034
9615300
100
0
IN PATIENT PHYSIOTHERAPY (PARTIAL)
95550-00[1920]
760035
9555000
100
0
Includes an assessment by Rehabilitation Consultant. Twelve
760036
5,400.00
-12
0
Includes an assessment by Rehabilitation Consultant.Twelve
760037
7,300.00
(12) rehab sessions within a month.Two (2) hours for each session, which includes either physiotherapy, occupational therapy , speech therapy
0
Includes examination in joints replacement surgical clinic, labora
760038
1,800.00
0
Includes examination in joints replacement surgical clinic, laboratory tests, and basic radiology.
760039
1,800.00
0
Includes three (3) sessions per week. One (1) hour for each
760040
900
sessi
0
Includes three(3) sessions per week. One (1) hour for each session, which includes either physiotherapy or occupational therapy or speech therapy or all of them together as patient�s need
760041
900
0
Infra Red
32135-01[941]
760042
3213501
60
0
Initial Assessment of patients which is counted unless the
760043
1,600.00
patien
0
Initial Assessment of patients which is counted unless the patient is admitted in the City for one of the rehabilitation
760044
1,600.00
program.
0
Inpatient Rehabilitation Program Joints
760045
2,500.00
replacement.Prostheses.
0
Inpatient Rehabilitation Program Joints replacement.Prostheses.Rheumatic conditionsGeneral
760046
2,500.00
0
OCCUPATIONAL THERAPY/SESSION
95550-02[1916]
750072
9555002
260
0
ORGANICITY BATTERY
750073
240
0
PARAFFIN WAX
750074
97018
90
0
PELVIC TRACTION
750075
97012
90
0
PERCEPTUAL TESTING FOR LEARNING DISABILITY
750076
9611000
320
0
PERSONALITY QUESTIONNAIRE
750077
240
0
PHOBIC SCALE
750078
240
0
PHYCHOMETRIC TEST (I.Q.)
95550-03[1916]
750079
95550003
440
0
PHYSICAL THERAPY INSTRUCTIONS
95550-03[1916]
750080
9555003
60
0
PHYSIOTHERAPY AT HOME/SESSION
750081
390
0
PORTEUS MAZES TEST
750082
240
0
PROGRESSIVE MATRIAS TEST
750083
240
0
PROGRESSIVE MUSCLE RELAXATION
750084
240
0
PSYCHIATRY EMERGENCY CONSULTATION
750085
600
0
PSYCHIATRY EVALUATION ADMINISTRATIVE FEE
750086
200
0
PSYCHIATRY FOLLOW-UP
750087
280
0
PSYCHIATRY HOME VISIT
750088
1,600.00
0
PSYCHOLOGICAL COUNSELLING
750089
360
0
PSYCHOTHERAPY, EACH SESSION
750090
240
0
RAIVEN PROGRESSIVE MATRICAS
750091
120
0
REH PK/DAY INC INVS EXC MEDS/SUPPLIES
750092
1,600.00
0
REH. PACK/DAY EXCL INVS/MEDS/SUPPLIES
750093
1,000.00
0
RIGHT- LEFT ORIENTATION TEST
750094
9611300
120
0
RORSCHACH TEST
750095
280
0
SENTENCE COMPLETION TEST
750096
120
0
SHORT WAVE
750097
29450
90
0
SOCIAL WORKERS ASSESS./VISIT
750098
260
0
SOMLEC THERAPY SESSION
750099
440
0
SPEECH THERAPY/SESSION
95550-05[1916]
750100
9613500
260
0
STANFORD -BINET INTELLIGENCE SCALE
750101
440
0
TAYLOR ANXIETY SCALE
750102
120
0
TENS
750103
90
0
THEMATIC APPRECEPTION TEST
750104
360
0
THERAPEUTIC EX
750105
80
0
THERAPEUTIC EX 30 MIN.SESSION
750106
150
0
TRAIL MAKING TEST
750107
160
0
TUNNEL P.U.V.A.
750108
96912
80
0
ULTRA VIOLET
750109
96912
80
0
ULTRASONIC
90908-00[1950]
750110
9090800
90
0
VINELAND ADAPATIVE BEHAVIOR SCALES
750111
200
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