|
Treat knee fracture 27530
|
$1,260.00 |
$1,260.00 |
$1,260.00 |
$550.00
|
|
Treat knee fracture(s)
|
$991.20 |
$991.20 |
$991.20 |
$642.00
|
|
Treat knuckle dislocation
|
$1,220.80 |
$1,220.80 |
$1,220.80 |
$1,523.90
|
|
Treat knuckle dislocation
|
$4,726.40 |
$4,726.40 |
$4,726.40 |
$4,332.00
|
|
Treat lower jaw fracture 21462
|
$14,604.80 |
$14,604.80 |
$14,604.80 |
$7,000.36
|
|
Treat lower leg bone lesion
|
$6,675.20 |
$6,675.20 |
$6,675.20 |
$3,977.49
|
|
Treat lower leg dislocation
|
$935.20 |
$935.20 |
$935.20 |
$530.75
|
|
Treat lower leg dislocation
|
$3,908.80 |
$3,908.80 |
$3,908.80 |
$3,908.80
|
|
Treat lower leg dislocation
|
$14,481.60 |
$14,481.60 |
$14,481.60 |
$6,311.00
|
|
Treat lower leg fracture
|
$17,382.40 |
$17,382.40 |
$17,382.40 |
$6,475.41
|
|
Treat lower leg fracture
|
$24,768.80 |
$24,768.80 |
$24,768.80 |
$14,241.77
|
|
Treat lower leg fracture
|
$24,768.80 |
$24,768.80 |
$24,768.80 |
$12,653.00
|
|
Treat lower leg joint
|
$13,759.20 |
$13,759.20 |
$13,759.20 |
$7,807.24
|
|
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah)
|
$4,950.40 |
$4,950.40 |
$4,950.40 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah)
|
$16,872.80 |
$16,872.80 |
$16,872.80 |
$8,590.40
|
|
Treatment fx radial distal open w/internal fixation left (restricted method ii cah)
|
$4,950.40 |
$4,950.40 |
$4,950.40 |
$8,370.75
|
|
Treatment incomplete abortion completed surgically any trimester
|
$9,794.40 |
$9,794.40 |
$9,794.40 |
$3,916.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$459.20 |
$459.20 |
$459.20 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$163.52 |
$163.52 |
$163.52 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$464.80 |
$464.80 |
$464.80 |
$203.35
|
|
Treatment missed abortion completed surgically 1st trimester
|
$9,794.40 |
$9,794.40 |
$9,794.40 |
$3,982.44
|
|
Treatment mouth roof lesion
|
$8,008.00 |
$8,008.00 |
$8,008.00 |
$4,256.70
|
|
Treatment of anal fissure
|
$3,477.60 |
$3,477.60 |
$3,477.60 |
$1,375.98
|
|
Treatment of anal fissure w/dilat 46940
|
$8,909.60 |
$8,909.60 |
$8,909.60 |
$3,245.23
|
|
Treatment of ankle fracture
|
$19,857.60 |
$19,857.60 |
$19,857.60 |
$8,412.89
|
|
Treatment of ankle fracture
|
$19,857.60 |
$19,857.60 |
$19,857.60 |
$8,453.60
|
|
Treatment of ankle fracture
|
$19,857.60 |
$19,857.60 |
$19,857.60 |
$7,907.11
|
|
Treatment of ankle fracture
|
$19,857.60 |
$19,857.60 |
$19,857.60 |
$7,913.97
|
|
Treatment of ankle fracture 27786
|
$1,125.60 |
$1,125.60 |
$1,125.60 |
$520.80
|
|
Treatment of choroid lesion
|
$2,951.20 |
$2,951.20 |
$2,951.20 |
$1,253.20
|
|
Treatment of corneal lesion
|
$856.80 |
$856.80 |
$856.80 |
$856.80
|
|
Treatment of eyelid lesions
|
$879.20 |
$879.20 |
$879.20 |
$353.74
|
|
Treatment of fibula fracture
|
$19,857.60 |
$19,857.60 |
$19,857.60 |
$6,311.00
|
|
Treatment of fibula fracture 27780
|
$935.20 |
$935.20 |
$935.20 |
$491.50
|
|
Treatment of foot infection
|
$7,694.40 |
$7,694.40 |
$7,694.40 |
$2,614.25
|
|
Treatment of foot infection
|
$6,412.00 |
$6,412.00 |
$6,412.00 |
$3,821.05
|
|
Treatment of gum lesion
|
$5,633.60 |
$5,633.60 |
$5,633.60 |
$3,164.85
|
|
Treatment of heel fracture 28400
|
$935.20 |
$935.20 |
$935.20 |
$473.00
|
|
Treatment of miscarriage
|
$9,794.40 |
$9,794.40 |
$9,794.40 |
$4,146.69
|
|
Treatment of mouth lesion physical 40820
|
$8,008.00 |
$8,008.00 |
$8,008.00 |
$3,589.62
|
|
Treatment of penis lesion
|
$11,508.00 |
$11,508.00 |
$11,508.00 |
$4,081.37
|
|
Treatment of penis lesion
|
$7,106.40 |
$7,106.40 |
$7,106.40 |
$3,515.40
|
|
Treatment of rectal prolapse
|
$1,052.80 |
$1,052.80 |
$1,052.80 |
$1,052.80
|
|
Treatment of retinal lesion
|
$1,741.60 |
$1,741.60 |
$1,741.60 |
$1,580.87
|
|
Treatment of retinal lesion
|
$1,590.40 |
$1,590.40 |
$1,590.40 |
$1,033.14
|
|
Treatment of retinal lesion
|
$8,467.20 |
$8,467.20 |
$8,467.20 |
$5,405.82
|
|
Treatment of thigh fracture
|
$1,030.40 |
$1,030.40 |
$1,030.40 |
$476.16
|
|
Treatment of thigh fracture
|
$1,624.00 |
$1,624.00 |
$1,624.00 |
$1,748.40
|
|
Treatment of thigh fracture
|
$1,086.40 |
$1,086.40 |
$1,086.40 |
$548.90
|
|
Treatment of thigh fracture
|
$6,389.60 |
$6,389.60 |
$6,389.60 |
$6,389.60
|
|
Treatment of thigh fracture
|
$1,383.20 |
$1,383.20 |
$1,383.20 |
$1,772.97
|
|
Treatment of tibia fracture
|
$11,692.80 |
$11,692.80 |
$11,692.80 |
$6,183.84
|
|
Treatment of tibia fracture
|
$17,998.40 |
$17,998.40 |
$17,998.40 |
$8,665.60
|
|
Treatment of tibia fracture
|
$21,358.40 |
$21,358.40 |
$21,358.40 |
$7,087.60
|
|
Treatment of toe fracture 28510
|
$1,125.60 |
$1,125.60 |
$1,125.60 |
$369.70
|
|
Treatment of urethra lesion
|
$11,508.00 |
$11,508.00 |
$11,508.00 |
$4,061.71
|
|
Treatment of urethra lesion
|
$8,215.20 |
$8,215.20 |
$8,215.20 |
$3,817.53
|
|
Treatment of urethra lesion
|
$7,336.00 |
$7,336.00 |
$7,336.00 |
$2,874.36
|
|
Treatment radiation delivery level 2
|
$1,237.60 |
$1,237.60 |
$1,237.60 |
$767.65
|
|
Treatment x10sv retinopathy
|
$2,889.60 |
$2,889.60 |
$2,889.60 |
$1,513.20
|
|
Treat metacarpal fracture
|
$9,788.80 |
$9,788.80 |
$9,788.80 |
$3,977.49
|
|
Treat metacarpal fracture
|
$10,925.60 |
$10,925.60 |
$10,925.60 |
$5,464.97
|
|
Treat metatarsal fracture
|
$9,564.80 |
$9,564.80 |
$9,564.80 |
$3,839.54
|
|
Treat metatarsal fracture
|
$13,759.20 |
$13,759.20 |
$13,759.20 |
$8,453.60
|
|
Treat midfoot fracture each
|
$1,114.40 |
$1,114.40 |
$1,114.40 |
$1,851.78
|
|
Treat midfoot fracture each
|
$19,465.60 |
$19,465.60 |
$19,465.60 |
$6,192.78
|
|
Treat pelvic fracture(s)
|
$1,506.40 |
$1,506.40 |
$1,506.40 |
$1,506.40
|
|
Treat pelvic ring fracture
|
$2,223.20 |
$2,223.20 |
$2,223.20 |
$2,223.20
|
|
Treat pelvic ring fracture
|
$2,727.20 |
$2,727.20 |
$2,727.20 |
$2,727.20
|
|
Treat pelvic ring fracture
|
$3,332.00 |
$3,332.00 |
$3,332.00 |
$3,332.00
|
|
Treat penis lesion graft
|
$10,416.00 |
$10,416.00 |
$10,416.00 |
$6,015.75
|
|
Treat penis lesion graft
|
$12,387.20 |
$12,387.20 |
$12,387.20 |
$10,235.30
|
|
Treat radius fracture
|
$13,339.20 |
$13,339.20 |
$13,339.20 |
$7,807.24
|
|
Treat radius fracture
|
$21,683.20 |
$21,683.20 |
$21,683.20 |
$14,061.89
|
|
Treat sesamoid bone fracture
|
$9,744.00 |
$9,744.00 |
$9,744.00 |
$7,907.11
|
|
Treat skull fracture
|
$8,181.60 |
$8,181.60 |
$8,181.60 |
$3,837.72
|
|
Treat spinal cord lesion
|
$2,520.00 |
$2,520.00 |
$2,520.00 |
$1,142.50
|
|
Treat spinal cord lesion
|
$4,575.20 |
$4,575.20 |
$4,575.20 |
$1,337.00
|
|
Treat sternum fracture
|
$1,125.60 |
$1,125.60 |
$1,125.60 |
$423.00
|
|
Treat tail bone fracture
|
$7,968.80 |
$7,968.80 |
$7,968.80 |
$3,839.54
|
|
Treat thigh fracture
|
$980.00 |
$980.00 |
$980.00 |
$661.00
|
|
Treat thigh fracture
|
$15,019.20 |
$15,019.20 |
$15,019.20 |
$6,510.40
|
|
Treat thigh fracture
|
$1,114.40 |
$1,114.40 |
$1,114.40 |
$1,893.86
|
|
Treat thigh fracture
|
$1,120.00 |
$1,120.00 |
$1,120.00 |
$618.80
|
|
Treat thigh fx growth plate
|
$1,052.80 |
$1,052.80 |
$1,052.80 |
$475.68
|
|
Treat thigh fx growth plate
|
$1,310.40 |
$1,310.40 |
$1,310.40 |
$1,938.38
|
|
Treat thumb fracture
|
$2,508.80 |
$2,508.80 |
$2,508.80 |
$2,508.80
|
|
Treat thumb fracture
|
$3,147.20 |
$3,147.20 |
$3,147.20 |
$3,786.00
|
|
Treat toe dislocation
|
$7,968.80 |
$7,968.80 |
$7,968.80 |
$3,839.54
|
|
Treat toe dislocation
|
$890.40 |
$890.40 |
$890.40 |
$756.39
|
|
Treat toe dislocation
|
$7,968.80 |
$7,968.80 |
$7,968.80 |
$3,821.05
|
|
Treat toe fracture
|
$2,508.80 |
$2,508.80 |
$2,508.80 |
$3,839.54
|
|
Treat trigeminal nerve
|
$5,924.80 |
$5,924.80 |
$5,924.80 |
$3,754.40
|
|
Treat trigeminal tract
|
$7,106.40 |
$7,106.40 |
$7,106.40 |
$4,350.00
|
|
Treat ulnar fracture
|
$1,220.80 |
$1,220.80 |
$1,220.80 |
$1,662.00
|
|
Treat ulnar fracture
|
$19,857.60 |
$19,857.60 |
$19,857.60 |
$5,926.25
|
|
Treat vaginal bleeding
|
$1,299.20 |
$1,299.20 |
$1,299.20 |
$379.60
|
|
Treat wrist bone fracture
|
$1,142.40 |
$1,142.40 |
$1,142.40 |
$1,548.40
|
|
Treat wrist dislocation
|
$1,125.60 |
$1,125.60 |
$1,125.60 |
$656.25
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$66,774.33 |
$66,774.33 |
$66,774.33 |
$73,346.25
|
