Therapy
Description CPT Charge Amount
Aquatic therapy/exercises 97113 $210.00
Auditor evoke potent limit 92586 $401.50
Elec stim other than wound G0283 $89.50
Evaluate swallowing function 92610 $432.50
Family training and counseling for child development, per 15 minutes T1027 $59.50
Gait training therapy 97116 $98.50
Group therapeutic procedures 97150 $70.50
Manual therapy 1/> regions 97140 $103.50
Neuromuscular reeducation 97112 $122.00
Oral function therapy 92526 $251.00
Ot eval low complex 30 min 97165 $365.00
Ot eval mod complex 45 min 97166 $365.00
Pt eval low complex 20 min 97161 $365.00
Pt eval mod complex 30 min 97162 $365.00
Self care mngment training 97535 $102.00
Speech sound lang comprehen 92523 $286.00
Speech/hearing therapy 92507 $229.00
Ther ivntj w/focus cog funcj 97127 $223.50
Therapeutic activities 97530 $112.50
Therapeutic exercises 97110 $118.00
Vasopneumatic device therapy 97016 $131.00
Cardiac
Description CPT Charge Amount
Cardiac rehab/monitor (hospital only) 93798 $192.00
Cardiovascular stress test 93015 $1059.50
Doppler color flow add-on 93325 $1262.50
Doppler echo exam heart 93320 $929.50
Doppler echo exam heart 93321 $504.00
Echo transesophageal 93312 $2596.00
Electrocardiogram complete 93000 $179.50
Extracranial bilat study 93880 $1445.50
Extremity study 93970 $1604.00
Extremity study 93971 $1070.00
Tte w/doppler complete 93306 $4179.50
Upr/l xtremity art 2 levels 93922 $1001.00
Injection
Description CPT Charge Amount
Chemo iv infus each addl seq 96417 $885.50
Chemo iv infusion 1 hr 96413 $756.00
Chemo iv infusion addl hr 96415 $364.00
Chemo iv push addl drug 96411 $64.50
Hydrate iv infusion add-on 96361 $92.50
Hydration iv infusion init 96360 $564.00
Immunization admin 90471 $27.00
Ther/proph/diag inj iv push 96374 $222.50
Ther/proph/diag inj sc/im 96372 $222.50
Ther/proph/diag iv inf addon 96366 $122.50
Ther/proph/diag iv inf init 96365 $563.50
Tx/pro/dx inj new drug addon 96375 $138.50
Tx/pro/dx inj same drug adon 96376 $53.00
Tx/proph/dg addl seq iv inf 96367 $350.50
Respiratory
Description CPT Charge Amount
Co/membane diffuse capacity 94729 $396.00
Evaluation of wheezing 94060 $499.00
Exhaled carbon dioxide test 94770 $259.50
Pulm funct tst plethysmograp 94726 $704.50
Pulmonary rehab w exer G0424 $103.00
Sleep
Description CPT Charge Amount
Eeg monitoring/videorecord 95951 $4888.00
Polysom 6/> yrs 4/> param 95810 $3934.50
Radiation Oncology
Description CPT Charge Amount
IMRT DELIVERY,INCL GUID/TRACK,COMPLEX 77386 $4291.00
TREATMENT,COMPLEX,6-10 MEV 77412 $1321.00
TREATMENT,RADIATION,INTERMEDIATE,>1 MEV 77407 $478.00
TREATMENT,RADIATION,SIMPLE,>1 MEV 77402 $841.00
TREATMENT,SIMPLE,>1 MEV 77402 $841.00