|
Treat kneecap fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$5,741.00
|
|
Treat knee dislocation
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,592.08
|
|
Treat knee fracture 27530
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$580.20
|
|
Treat knee fracture(s)
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$642.00
|
|
Treat knuckle dislocation
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,893.86
|
|
Treat knuckle dislocation
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,839.54
|
|
Treat lower jaw fracture 21462
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$6,311.00
|
|
Treat lower leg bone lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,839.54
|
|
Treat lower leg dislocation
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$532.60
|
|
Treat lower leg dislocation
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,350.00
|
|
Treat lower leg dislocation
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$6,072.59
|
|
Treat lower leg fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$5,886.74
|
|
Treat lower leg fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$12,905.86
|
|
Treat lower leg fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$12,653.00
|
|
Treat lower leg joint
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$7,807.24
|
|
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah)
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah)
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation left (restricted method ii cah)
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$8,370.75
|
|
Treatment incomplete abortion completed surgically any trimester
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,806.40
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$120.31 |
$120.31 |
$120.31 |
$210.00
|
|
Treatment missed abortion completed surgically 1st trimester
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,820.53
|
|
Treatment mouth roof lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,350.00
|
|
Treatment of anal fissure
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,073.68
|
|
Treatment of anal fissure w/dilat 46940
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,997.10
|
|
Treatment of ankle fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$7,907.11
|
|
Treatment of ankle fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$7,907.11
|
|
Treatment of ankle fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$7,348.32
|
|
Treatment of ankle fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$7,807.24
|
|
Treatment of ankle fracture 27786
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$580.00
|
|
Treatment of choroid lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,126.50
|
|
Treatment of corneal lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$436.44
|
|
Treatment of eyelid lesions
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$326.69
|
|
Treatment of fibula fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$7,069.90
|
|
Treatment of fibula fracture 27780
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$558.75
|
|
Treatment of foot infection
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,893.86
|
|
Treatment of foot infection
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,594.44
|
|
Treatment of gum lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,164.85
|
|
Treatment of heel fracture 28400
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$494.00
|
|
Treatment of miscarriage
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,146.69
|
|
Treatment of mouth lesion physical 40820
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,544.29
|
|
Treatment of penis lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,081.37
|
|
Treatment of penis lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,386.84
|
|
Treatment of rectal prolapse
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,010.01
|
|
Treatment of retinal lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,580.87
|
|
Treatment of retinal lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,522.19
|
|
Treatment of retinal lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,881.00
|
|
Treatment of thigh fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$467.25
|
|
Treatment of thigh fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,893.86
|
|
Treatment of thigh fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$659.00
|
|
Treatment of thigh fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$6,651.45
|
|
Treatment of thigh fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,055.00
|
|
Treatment of tibia fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$6,183.84
|
|
Treatment of tibia fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$5,110.00
|
|
Treatment of tibia fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$6,347.40
|
|
Treatment of toe fracture 28510
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$371.40
|
|
Treatment of urethra lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,891.34
|
|
Treatment of urethra lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,935.76
|
|
Treatment of urethra lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,424.12
|
|
Treatment radiation delivery level 2
|
$156.72 |
$156.72 |
$156.72 |
$735.00
|
|
Treatment x10sv retinopathy
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,574.83
|
|
Treat metacarpal fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,958.50
|
|
Treat metacarpal fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$4,627.00
|
|
Treat metatarsal fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,839.54
|
|
Treat metatarsal fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$7,913.97
|
|
Treat midfoot fracture each
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,893.86
|
|
Treat midfoot fracture each
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$6,192.78
|
|
Treat penis lesion graft
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$5,631.74
|
|
Treat penis lesion graft
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$7,976.07
|
|
Treat radius fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$6,750.12
|
|
Treat radius fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$9,499.20
|
|
Treat sesamoid bone fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$5,855.00
|
|
Treat skull fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,621.80
|
|
Treat spinal cord lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$985.43
|
|
Treat spinal cord lesion
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,304.32
|
|
Treat sternum fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$423.00
|
|
Treat tail bone fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,786.00
|
|
Treat thigh fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$661.00
|
|
Treat thigh fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$7,372.60
|
|
Treat thigh fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$2,021.04
|
|
Treat thigh fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$716.95
|
|
Treat thigh fx growth plate
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$421.50
|
|
Treat thigh fx growth plate
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,938.38
|
|
Treat thumb fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,839.54
|
|
Treat thumb fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,839.54
|
|
Treat toe dislocation
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,839.54
|
|
Treat toe dislocation
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$855.66
|
|
Treat toe dislocation
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,111.65
|
|
Treat toe fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,981.06
|
|
Treat trigeminal nerve
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,610.79
|
|
Treat trigeminal tract
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$3,786.00
|
|
Treat ulnar fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,861.60
|
|
Treat ulnar fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$5,419.00
|
|
Treat vaginal bleeding
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$400.86
|
|
Treat wrist bone fracture
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$1,907.64
|
|
Treat wrist dislocation
|
$5,855.00 |
$5,855.00 |
$5,855.00 |
$760.00
|
|
Treponema pallidum ag if
|
$13.40 |
$13.40 |
$13.40 |
$13.40
|
|
Treponema pallidum antibody
|
$14.56 |
$14.56 |
$14.56 |
$72.80
|
|
Trg gene rearrangement anal
|
$221.65 |
$221.65 |
$221.65 |
$455.70
|
|
Trh stimulation panel
|
$73.93 |
$73.93 |
$73.93 |
$73.93
|
|
Trichinella antibody
|
$13.82 |
$13.82 |
$13.82 |
$70.65
|
