|
Treat knuckle dislocation
|
$1,408.80 |
$1,408.80 |
$1,408.80 |
$4,332.00
|
|
Treat lower jaw fracture 21462
|
$5,276.00 |
$5,276.00 |
$5,276.00 |
$7,000.36
|
|
Treat lower leg bone lesion
|
$2,995.20 |
$2,995.20 |
$2,995.20 |
$4,092.85
|
|
Treat lower leg dislocation
|
$1,892.80 |
$1,892.80 |
$1,892.80 |
$532.60
|
|
Treat lower leg dislocation
|
$1,982.40 |
$1,982.40 |
$1,982.40 |
$3,908.80
|
|
Treat lower leg dislocation
|
$3,716.80 |
$3,716.80 |
$3,716.80 |
$6,072.59
|
|
Treat lower leg fracture
|
$4,198.40 |
$4,198.40 |
$4,198.40 |
$6,475.41
|
|
Treat lower leg fracture
|
$5,465.60 |
$5,465.60 |
$5,465.60 |
$12,905.86
|
|
Treat lower leg fracture
|
$6,499.20 |
$6,499.20 |
$6,499.20 |
$12,653.00
|
|
Treat lower leg joint
|
$3,452.80 |
$3,452.80 |
$31,932.42 |
$6,905.00
|
|
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah)
|
$4,059.20 |
$4,059.20 |
$34,307.86 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah)
|
$5,166.40 |
$5,166.40 |
$5,166.40 |
$8,590.40
|
|
Treatment fx radial distal open w/internal fixation left (restricted method ii cah)
|
$3,619.20 |
$3,619.20 |
$29,691.72 |
$8,370.75
|
|
Treatment incomplete abortion completed surgically any trimester
|
$5,269.41 |
$5,269.41 |
$13,058.99 |
$3,996.00
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$202.78 |
$202.78 |
$241.15 |
$226.20
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$93.60 |
$93.60 |
$202.78 |
$148.35
|
|
Treatment missed abortion completed surgically 1st trimester
|
$993.60 |
$993.60 |
$13,143.26 |
$4,230.80
|
|
Treatment mouth roof lesion
|
$577.60 |
$577.60 |
$577.60 |
$4,256.70
|
|
Treatment of anal fissure
|
$578.40 |
$578.40 |
$578.40 |
$1,278.72
|
|
Treatment of anal fissure w/dilat 46940
|
$607.20 |
$607.20 |
$607.20 |
$3,640.00
|
|
Treatment of ankle fracture
|
$3,190.40 |
$3,190.40 |
$3,190.40 |
$7,913.97
|
|
Treatment of ankle fracture
|
$3,779.20 |
$3,779.20 |
$31,430.44 |
$8,453.60
|
|
Treatment of ankle fracture
|
$4,267.20 |
$4,267.20 |
$37,995.74 |
$7,906.00
|
|
Treatment of ankle fracture
|
$4,824.00 |
$4,824.00 |
$4,824.00 |
$7,906.00
|
|
Treatment of ankle fracture 27786
|
$1,540.80 |
$1,540.80 |
$1,540.80 |
$528.00
|
|
Treatment of choroid lesion
|
$2,641.60 |
$2,641.60 |
$2,641.60 |
$1,253.20
|
|
Treatment of corneal lesion
|
$1,612.80 |
$1,612.80 |
$1,612.80 |
$856.80
|
|
Treatment of eyelid lesions
|
$315.20 |
$315.20 |
$315.20 |
$352.04
|
|
Treatment of fibula fracture
|
$3,502.40 |
$3,502.40 |
$3,502.40 |
$6,307.00
|
|
Treatment of fibula fracture 27780
|
$1,502.40 |
$1,502.40 |
$1,502.40 |
$528.00
|
|
Treatment of foot infection
|
$1,109.60 |
$1,109.60 |
$1,109.60 |
$2,928.60
|
|
Treatment of foot infection
|
$1,757.60 |
$1,757.60 |
$1,757.60 |
$3,839.54
|
|
Treatment of head injury 62010
|
$3,604.00 |
$3,604.00 |
$3,604.00 |
$3,604.00
|
|
Treatment of heel fracture 28400
|
$1,216.00 |
$1,216.00 |
$1,216.00 |
$478.40
|
|
Treatment of miscarriage
|
$988.80 |
$988.80 |
$988.80 |
$4,146.69
|
|
Treatment of mouth lesion physical 40820
|
$638.40 |
$638.40 |
$638.40 |
$3,734.50
|
|
Treatment of penis lesion
|
$1,575.20 |
$1,575.20 |
$1,575.20 |
$4,081.37
|
|
Treatment of penis lesion
|
$1,140.00 |
$1,140.00 |
$1,140.00 |
$3,515.40
|
|
Treatment of rectal prolapse
|
$380.80 |
$380.80 |
$380.80 |
$1,052.80
|
|
Treatment of retinal lesion
|
$2,982.40 |
$2,982.40 |
$2,982.40 |
$1,741.60
|
|
Treatment of retinal lesion
|
$2,566.40 |
$2,566.40 |
$2,566.40 |
$1,336.20
|
|
Treatment of retinal lesion
|
$6,939.20 |
$6,939.20 |
$6,939.20 |
$5,419.00
|
|
Treatment of thigh fracture
|
$2,484.80 |
$2,484.80 |
$2,484.80 |
$487.50
|
|
Treatment of thigh fracture
|
$3,939.20 |
$3,939.20 |
$3,939.20 |
$1,749.06
|
|
Treatment of thigh fracture
|
$6,582.40 |
$6,582.40 |
$6,582.40 |
$4,785.00
|
|
Treatment of thigh fracture
|
$2,574.40 |
$2,574.40 |
$2,574.40 |
$570.40
|
|
Treatment of thigh fracture
|
$3,248.00 |
$3,248.00 |
$3,248.00 |
$6,389.60
|
|
Treatment of thigh fracture
|
$3,347.20 |
$3,347.20 |
$3,347.20 |
$1,790.00
|
|
Treatment of thigh fracture
|
$4,920.00 |
$4,920.00 |
$4,920.00 |
$2,896.50
|
|
Treatment of thigh fracture
|
$4,780.80 |
$4,780.80 |
$4,780.80 |
$2,254.50
|
|
Treatment of thigh fracture
|
$6,115.20 |
$6,115.20 |
$6,115.20 |
$4,380.00
|
|
Treatment of thigh fracture
|
$4,768.00 |
$4,768.00 |
$4,768.00 |
$3,796.00
|
|
Treatment of tibia fracture
|
$2,827.20 |
$2,827.20 |
$2,827.20 |
$6,183.84
|
|
Treatment of tibia fracture
|
$4,400.00 |
$4,400.00 |
$4,400.00 |
$6,347.40
|
|
Treatment of tibia fracture
|
$4,913.60 |
$4,913.60 |
$4,913.60 |
$7,087.60
|
|
Treatment of toe fracture 28510
|
$300.80 |
$300.80 |
$300.80 |
$371.40
|
|
Treatment of urethra lesion
|
$1,138.40 |
$1,138.40 |
$1,138.40 |
$4,061.71
|
|
Treatment of urethra lesion
|
$509.60 |
$509.60 |
$509.60 |
$4,061.71
|
|
Treatment of urethra lesion
|
$559.20 |
$559.20 |
$559.20 |
$2,874.36
|
|
Treatment radiation delivery level 2
|
$1,754.35 |
$1,754.35 |
$1,754.35 |
$867.24
|
|
Treatment x10sv retinopathy
|
$3,531.20 |
$3,531.20 |
$3,531.20 |
$1,513.20
|
|
Treat metacarpal fracture
|
$1,179.20 |
$1,179.20 |
$1,179.20 |
$4,289.60
|
|
Treat metacarpal fracture
|
$1,414.40 |
$1,414.40 |
$1,414.40 |
$5,741.00
|
|
Treat metatarsal fracture
|
$906.40 |
$906.40 |
$906.40 |
$3,839.54
|
|
Treat metatarsal fracture
|
$1,378.40 |
$1,378.40 |
$1,378.40 |
$8,241.00
|
|
Treat midfoot fracture each
|
$2,855.64 |
$2,855.64 |
$2,855.64 |
$1,893.86
|
|
Treat midfoot fracture each
|
$1,570.40 |
$1,570.40 |
$1,570.40 |
$6,445.00
|
|
Treat neck spine fracture
|
$3,572.80 |
$3,572.80 |
$3,572.80 |
$3,572.80
|
|
Treat odontoid fx without graft
|
$3,868.80 |
$3,868.80 |
$3,868.80 |
$5,448.00
|
|
Treat penis lesion graft
|
$2,021.60 |
$2,021.60 |
$2,021.60 |
$5,986.78
|
|
Treat penis lesion graft
|
$2,368.00 |
$2,368.00 |
$2,368.00 |
$7,976.07
|
|
Treat radius fracture
|
$3,220.80 |
$3,220.80 |
$3,220.80 |
$7,907.11
|
|
Treat radius fracture
|
$3,608.00 |
$3,608.00 |
$3,608.00 |
$9,791.00
|
|
Treat sesamoid bone fracture
|
$1,684.80 |
$1,684.80 |
$1,684.80 |
$7,907.11
|
|
Treat skull fracture
|
$2,425.60 |
$2,425.60 |
$2,425.60 |
$3,837.72
|
|
Treat skull fracture
|
$2,984.80 |
$2,984.80 |
$2,984.80 |
$2,984.80
|
|
Treat slipped epiphysis
|
$4,524.80 |
$4,524.80 |
$4,524.80 |
$3,359.20
|
|
Treat spinal cord lesion
|
$862.40 |
$862.40 |
$862.40 |
$1,142.50
|
|
Treat spinal cord lesion
|
$594.40 |
$594.40 |
$594.40 |
$1,337.00
|
|
Treat spine fracture
|
$3,485.60 |
$3,485.60 |
$3,485.60 |
$3,485.60
|
|
Treat sternum fracture
|
$356.00 |
$356.00 |
$356.00 |
$423.00
|
|
Treat tail bone fracture
|
$1,302.40 |
$1,302.40 |
$1,302.40 |
$3,839.54
|
|
Treat thigh fracture
|
$2,368.00 |
$2,368.00 |
$2,368.00 |
$661.00
|
|
Treat thigh fracture
|
$4,467.20 |
$4,467.20 |
$4,467.20 |
$6,510.40
|
|
Treat thigh fracture
|
$5,883.20 |
$5,883.20 |
$5,883.20 |
$3,933.60
|
|
Treat thigh fracture
|
$2,280.00 |
$2,280.00 |
$2,280.00 |
$1,893.86
|
|
Treat thigh fracture
|
$6,048.00 |
$6,048.00 |
$6,048.00 |
$4,726.80
|
|
Treat thigh fracture
|
$1,908.80 |
$1,908.80 |
$1,908.80 |
$618.80
|
|
Treat thigh fracture
|
$3,673.60 |
$3,673.60 |
$3,673.60 |
$2,802.80
|
|
Treat thigh fracture
|
$4,691.20 |
$4,691.20 |
$4,691.20 |
$2,008.18
|
|
Treat thigh fracture
|
$6,052.80 |
$6,052.80 |
$6,052.80 |
$3,580.50
|
|
Treat thigh fx growth plate
|
$2,510.40 |
$2,510.40 |
$2,510.40 |
$475.68
|
|
Treat thigh fx growth plate
|
$3,376.00 |
$3,376.00 |
$3,376.00 |
$1,938.38
|
|
Treat thorax spine fracture
|
$3,624.00 |
$3,624.00 |
$3,624.00 |
$3,624.00
|
|
Treat thumb fracture
|
$2,352.00 |
$2,352.00 |
$2,352.00 |
$2,508.80
|
|
Treat thumb fracture
|
$3,080.00 |
$3,080.00 |
$3,080.00 |
$3,839.54
|
|
Treat toe dislocation
|
$771.20 |
$771.20 |
$771.20 |
$3,839.54
|
|
Treat toe dislocation
|
$384.00 |
$384.00 |
$384.00 |
$756.00
|
|
Treat toe dislocation
|
$422.40 |
$422.40 |
$422.40 |
$3,839.54
|
|
Treat toe fracture
|
$1,426.40 |
$1,426.40 |
$1,426.40 |
$3,839.54
|
