|
Treat ectopic pregnancy
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,855.00
|
|
Treat ectopic pregnancy
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,000.90
|
|
Treat elbow dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,326.40
|
|
Treat elbow dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$7,292.92
|
|
Treat elbow fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$10,629.07
|
|
Treat elbow fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,125.60
|
|
Treat elbow fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$8,453.60
|
|
Treat eyelid by injection
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$472.21
|
|
Treat eyelid lesion 67850
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,146.13
|
|
Treat finger fracture each
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,108.00
|
|
Treat finger fracture each
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,815.75
|
|
Treat foot bone lesion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,839.54
|
|
Treat foot dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$435.60
|
|
Treat foot dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,935.24
|
|
Treat foot dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,856.00
|
|
Treat foot dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$527.28
|
|
Treat foot dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,183.84
|
|
Treat foot dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$478.40
|
|
Treat foot dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$404.04
|
|
Treat foot dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,778.28
|
|
Treat fracture of radius
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,030.33
|
|
Treat fracture of radius
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,316.75
|
|
Treat fracture of ulna
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$766.72
|
|
Treat/graft heel fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$10,629.07
|
|
Treat hand bone lesion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,893.86
|
|
Treat hand dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,893.86
|
|
Treat hand dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,591.33
|
|
Treat hand dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,839.54
|
|
Treat heel fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$7,907.11
|
|
Treat hip dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,561.90
|
|
Treat hip dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,152.05
|
|
Treat humerus fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,311.00
|
|
Treat humerus fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$11,850.08
|
|
Treat humerus fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,950.60
|
|
Treat humerus fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$12,653.00
|
|
Treat humerus fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$10,742.40
|
|
Treat humerus fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,045.35
|
|
Treat humerus fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$14,061.89
|
|
Treat humerus fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$9,346.40
|
|
Treat humerus fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,419.00
|
|
Treat kneecap dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,351.35
|
|
Treat kneecap dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,886.74
|
|
Treat kneecap fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,741.00
|
|
Treat knee dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,592.08
|
|
Treat knee fracture 27530
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$580.20
|
|
Treat knee fracture(s)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$642.00
|
|
Treat knuckle dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,893.86
|
|
Treat knuckle dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,839.54
|
|
Treat lower jaw fracture 21462
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,311.00
|
|
Treat lower leg bone lesion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,839.54
|
|
Treat lower leg dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$532.60
|
|
Treat lower leg dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,350.00
|
|
Treat lower leg dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,072.59
|
|
Treat lower leg fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,886.74
|
|
Treat lower leg fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$12,905.86
|
|
Treat lower leg fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$12,653.00
|
|
Treat lower leg joint
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$7,807.24
|
|
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation left (restricted method ii cah)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$8,370.75
|
|
Treatment incomplete abortion completed surgically any trimester
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,806.40
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$61.62 |
$61.62 |
$61.62 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$42.12 |
$42.12 |
$42.12 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$185.86 |
$185.86 |
$185.86 |
$210.00
|
|
Treatment missed abortion completed surgically 1st trimester
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,820.53
|
|
Treatment mouth roof lesion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,350.00
|
|
Treatment of anal fissure
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,073.68
|
|
Treatment of anal fissure w/dilat 46940
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,997.10
|
|
Treatment of ankle fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$7,907.11
|
|
Treatment of ankle fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$7,907.11
|
|
Treatment of ankle fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$7,348.32
|
|
Treatment of ankle fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$7,807.24
|
|
Treatment of ankle fracture 27786
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$580.00
|
|
Treatment of choroid lesion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,126.50
|
|
Treatment of corneal lesion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$436.44
|
|
Treatment of eyelid lesions
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$326.69
|
|
Treatment of fibula fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$7,069.90
|
|
Treatment of fibula fracture 27780
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$558.75
|
|
Treatment of foot infection
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,893.86
|
|
Treatment of foot infection
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,594.44
|
|
Treatment of gum lesion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,164.85
|
|
Treatment of heel fracture 28400
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$494.00
|
|
Treatment of miscarriage
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,146.69
|
|
Treatment of mouth lesion physical 40820
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,544.29
|
|
Treatment of penis lesion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,081.37
|
|
Treatment of penis lesion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,386.84
|
|
Treatment of rectal prolapse
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,010.01
|
|
Treatment of retinal lesion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,580.87
|
|
Treatment of retinal lesion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,522.19
|
|
Treatment of retinal lesion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,881.00
|
|
Treatment of thigh fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$467.25
|
|
Treatment of thigh fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,893.86
|
|
Treatment of thigh fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$659.00
|
|
Treatment of thigh fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,651.45
|
|
Treatment of thigh fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,055.00
|
|
Treatment of tibia fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,183.84
|
|
Treatment of tibia fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,110.00
|
|
Treatment of tibia fracture
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,347.40
|
|
Treatment of toe fracture 28510
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$371.40
|
|
Treatment of urethra lesion
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,891.34
|
