updated September 6, 2024
Complete Care recognizes that the financial aspect of your care may be confusing. Our commitment is to be as transparent as possible, and to provide you with information to make decisions about your health care.
Complete Care encourages patients who are scheduled for services or procedures to contact a Patient Liaison who can evaluate, calculate and provide patients with their actual out-of-pocket expense. Our Patient Liaison team can be reached at Patientbilling@complete-care.com.
| Fee Schedule for Injury Care & Rehab Services | ||
| CPT Code | Code Description | Billed Amt |
| 70030 | X-Ray Eye Foreign Body | $62.73 |
| 70100 | Xray of the Mandible; 1-3 views | $74.63 |
| 70110 | Xray of the mandible; 4 views | $83.67 |
| 70250 | Xray of the Skull; 1-3 vies | $71.07 |
| 70330 | Xray, temporomandibular joint, open and closed mouth;bilateral | $101.15 |
| 71045 | Xray, chest | $49.59 |
| 71046 | Xray, chest, single view | $64.77 |
| 71048 | X-ray chest, 4 or more view | $87.67 |
| 71100 | Xray, ribs, unilateral, 2 views | $70.43 |
| 71101 | Xray, ribs, unilateral, 3 views | $81.25 |
| 71110 | Xray, ribs, bilateral, 3 views | $84.45 |
| 71111 | Xray, ribs, bilateral, 4 views | $101.19 |
| 71120 | Xray, sternum, 2 views | $67.33 |
| 72040 | Xray, cervical, 2 or 3 views | $76.05 |
| 72050 | Xray, cervical, 4 views | $102.53 |
| 72052 | Xray, cervical, 6+ views | $121.93 |
| 72070 | Xray, thoracic, 2 views | $68.85 |
| 72072 | Xray, thoracic, 3 views | $76.17 |
| 72100 | Xray, lumbosacral, 2 or 3 views | $76.67 |
| 72110 | Xray, lumbosacral, 4 views | $100.93 |
| 72170 | Xray, pelvis, 1 or 2 views | $53.93 |
| 72220 | Xray, sacrum and coccyx, 2 views | $62.69 |
| 73000 | Xray, clavicle, complete | $62.65 |
| 73010 | Xray, scapula, complete | $55.35 |
| 73020 | Xray, shoulder, 1 view | $48.15 |
| 73030 | Xray, shoulder, 2 views | $67.13 |
| 73050 | Xray, acromioclavicular joints, bilateral, with or without weighted distraction | $70.17 |
| 73060 | Xray, humerus, 2 views | $61.41 |
| 73070 | Xray, elbow, 2 views | $56.41 |
| 73080 | Xray, elbow, 3 views | $63.33 |
| 73090 | Xray, forearm, 2 views | $56.41 |
| 73100 | Xray, hand, 2 views | $65.17 |
| 73110 | Xray, hand, 3 views | $78.97 |
| 73120 | Xray, wrist, complete, 3 views | $60.79 |
| 73130 | Xray, wrist, 2 views | $71.47 |
| 73140 | Xray, finger(s), 2 views | $73.17 |
| 73501 | Xray, hip, unilateral, with pelvis when performed, 1 view | $63.37 |
| 73502 | Xray, hip, unilateral, with pelvis when performed, 2-3 views | $91.07 |
| 73503 | Xray, hip, unilateral, with pelvis when performed, minimum of 4 views | $114.41 |
| 73521 | Xray, hips, bilateral, with pelvis when performed, 2 views | $79.17 |
| 73551 | Xray, femur, 1 view | $56.41 |
| 73552 | Xray, femur, 2 views | $68.37 |
| 73560 | Xray, knee; 1 or 2 views | $65.79 |
| 73562 | Xray, knee, 3 views | $78.39 |
| 73590 | Xray, tibia and fibula, 2 views | $60.79 |
| 73600 | Xray, ankle, 2 views | $62.03 |
| 73610 | Xray, ankle, complete, 3 views | $70.21 |
| 73620 | Xray, foot, 2 views | $55.15 |
| 73630 | Xray, foot, complete, 3 views | $65.83 |
| 73650 | Xray, calcaneus (heel bone), 2 views | $55.15 |
| 73660 | Xray, toe(s), 2 views | $56.29 |
| 76120 | Cineradiography/videoradiography, except where specifically included | $224.45 |
| 76499 | Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation | $500.00 |
| 76942 | Unlisted diagnostic radiographic procedure | $301.13 |
| 96138 | Psychological or neuropsychological test | $64.79 |
| 97010 | Application of a modality to 1 or more areas; hot or cold packs | $12.47 |
| 97012 | Application of a modality to 1 or more areas; traction, mechanical | $27.63 |
| 97014 | Application of a modality to 1 or more areas; electrical stimulation (unattended) | $24.21 |
| 97110 | Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility | $57.21 |
| 97112 | Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities | $65.55 |
| 97140 | Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes | $52.75 |
| 97150 | Therapeutic procedure(s), group (2 or more individuals) | $35.29 |
| 97161 | Physical Therapy Evaluation – Low Complexity | $195.91 |
| 97164 | Re-evaluation of physical therapy established plan of care | $135.67 |
| 97530 | Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes | $70.93 |
| 97535 | Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes | $63.47 |
| 97760 | Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes | $91.83 |
| 98940 | Chiropractic manipulative treatment (CMT); spinal, 1-2 regions | $53.49 |
| 98941 | Chiropractic manipulative treatment (CMT); spinal, 3-4 regions | $77.03 |
| 98942 | Chiropractic manipulative treatment (CMT); spinal, 5 regions | $99.29 |
| 98943 | Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions | $32.00 |
| 99202 | Office/Outpatient Visit, New Patient ~ 15-29 Min | $142.31 |
| 99203 | Office/Outpatient Visit, New Patient ~ 30-44 Min | $221.63 |
| 99204 | Office/Outpatient Visit, New Patient ~ 45-59 Min | $499.43 |
| 99211 | Office/Outpatient Visit, Established Patient ~ May not require the presence of a physician or other qualified health care professional | $44.87 |
| 99212 | Office/Outpatient Visit, Established Patient ~ 10-19 Min | $111.27 |
| 99213 | Office/Outpatient Visit, Established Patient ~ 20-29 Min | $179.53 |
| 99214 | Office/Outpatient Visit, Established Patient ~ 30-39 Min (Re-Exam) | $380.27 |
| 99441 | Telemed (Phone) ~ 5-10 Min | $110.31 |
| 99442 | Telemed (Phone) ~ 11-20 Min | $178.55 |
| 99443 | Telemed (Phone) ~ 21-30 Min | $253.51 |
| 99446 | Telemed (Phone/Internet) ~ 5-10 Min | $35.61 |
| 99448 | Telemed (Phone/Internet) ~ 21-30 Min | $107.47 |
| G0283 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care | $22.97 |
| J3490 | Lidocaine Patches | $354.80 |
| Mental Health | ||
| CPT Code | Code Description | Billed Amt |
| 90785 | Psytx complex interactive | $29.19 |
| 90791 | Psychiatric diagnostic eva; w/o medical services | $342.37 |
| 90792 | Psychiatric diagnostic eva; w/ medical services | $386.79 |
| 90832 | Individual psychotherapy, 30 mins | $155.91 |
| 90833 | Individual psychotherapy, 30 mins w/ eval and managament services (E/M) | $143.89 |
| 90834 | Individual psychotherapy, 45 mins | $205.49 |
| 90836 | Individual psychotherapy, 45 mins with E/M | $181.59 |
| 90837 | Individual psychotherapy, 60 mins | $303.01 |
| 90838 | Individual psychotherapy, 60 mins with E/M | $240.85 |
| 90839 | Psychotherapy for crisis, first 60 mins | $291.95 |
| 90840 | Psychotherapy for crisis, each additional 30 mins | $145.49 |
| 90845 | Psychoanalysis | $195.23 |
| 90846 | Family Psychotherapy w/o client present, 50 mins | $195.83 |
| 90847 | Family Psychotherapy w/ client present, 50 mins | $212.31 |
| 90853 | Group psychotherapy (other than multi-family group) | $59.55 |
| Neurology Testing | ||
| CPT Code | Code Description | Billed Amt |
| 95924 | NCV | $441.38 |
| 95923 | NCV | $351.59 |
| 95913 | NCV | $831.41 |
| 95912 | NCV | $719.99 |
| 95911 | NCV | $614.96 |
| 95910 | NCV | $509.54 |
| 95909 | NCV | $390.02 |
| 95908 | NCV | $325.10 |
| 95907 | NCV | $262.07 |
| 95905 | NCV | $96.14 |
| 95886 | EMG | $277.07 |
| 95885 | EMG | $176.27 |
| 95875 | EMG | $353.30 |
| 95870 | EMG | $237.53 |
| 95864 | EMG | $669.17 |
| 95863 | EMG | $598.88 |
| 95861 | EMG | $462.14 |
| 95860 | EMG | $324.71 |
| 95851 | EMG | $62.48 |
| 92540 | VNG | $310.94 |
| 92541 | VNG | $158.36 |
| 92542 | VNG | $161.81 |
| 92544 | VNG | $129.38 |
| 92545 | VNG | $118.58 |
| 92547 | VNG | $30.02 |
| 92546 | VNG | $376.91 |
| 92548 | Balance | $295.97 |
| 92537 | Caloric (4) | $116.33 |
| 92538 | Caloric (4) | $65.72 |
| 20553 | TPI (3 or more) | $180.08 |
| 20610 | Joint Injection | $200.63 |
| Durable Medical Equipment (DME) | ||
| CPT Code | Code Description | Billed Amt |
| A4467 | Knee Sleeve | $24.02 |
| A4565 | Sling | $21.01 |
| A9270 | Walker Boot | $133.73 |
| E0100 | Cane of any material | $57.51 |
| E0105 | 4 pronged cane | $134.03 |
| E0114 | Crutches | $128.77 |
| E0143 | Walker | $115.11 |
| E0720 | TENS | $172.77 |
| L0120 | Cervical Soft Collar | $66.19 |
| L0170 | Cervical collar (Molded) | $1,659.49 |
| L0172 | Cervical immobilizer collar | $336.45 |
| L0180 | Cervical collar (Multiple post) | $822.03 |
| L0456 | T. Back Brace | $2,353.15 |
| L0621 | Sacroiliac orthosis brace | $144.63 |
| L0623 | Sacroiliac Orthosis (SO) | $259.27 |
| L0625 | Soft LSO | $80.91 |
| L0627 | Lumbar Orthosis, sagittal control with rigid anterior and posterior panels | $972.59 |
| L0642 | Medium LSO (Used to be L0627) | $603.75 |
| L0648 | Rigid LSO (Used to be L0631) | $1,507.81 |
| L0650 | LSO | $1,744.63 |
| L1810 | Lateral stabilizer knee brace | $286.43 |
| L1820 | Knee brace | $285.29 |
| L1832 | Shortrunner knee brace | $1,783.65 |
| L1833 | Telescoping hinged knee brace | $1,051.81 |
| L1851 | OA knee brace (Used to be K0901) | $1,388.29 |
| L1902 | Ankle brace with or without joints | $180.73 |
| L1971 | AFO | $1,108.99 |
| L2397 | Cobra knee brace | $257.89 |
| L3660 | Shoulder orthosis figure of eight design abduction restrainer, canvas and webbing | $221.29 |
| L3670 | Shoulder Orthosis | $308.43 |
| L3675 | Shoulder stabilizer with vest component | $377.87 |
| L3807 | Wrist brace w/ thumb | $538.43 |
| L3908 | Wrist brace | $128.99 |
| L3915 | Wrist and hand brace | $1,144.63 |
| L3923 | Splint | $187.29 |
| L4360 | Cam Fracture Walking Boot | $647.31 |
| L4387 | Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf | $375.09 |
| Fee Schedule for Diagnostic Imaging | ||
| CPT Code | Code Description | Billed Amt |
| 70551 | MRI brain w/o dye | $1,028.90 |
| 71550 | MRI chest w/o dye | $1,045.10 |
| 72141 | MRI neck spine w/o dye | $1,006.02 |
| 72146 | MRI chest spine w/o dye (thoracic) | $1,076.74 |
| 72148 | MRI lumbar spine w/o dye | $1,066.28 |
| 72195 | MRI pelvis w/o dye | $1,012.46 |
| 73218 | MRI upper extremity w/o dye | $1,002.74 |
| 73221 | MRI joint upr extrem w/o dye | $984.30 |
| 73718 | MRI lower extremity w/o dye | $995.64 |
| 73721 | MRI jnt of lwr extre w/o dye | $989.26 |
| 74181 | MRI abdomen w/o dye | $978.40 |
| MRI Comparison: CPT code is dependent on the type of MRI being compared. | $152.44 | |
| Fee Schedule for Spine & Orthopedic Services | ||
| CPT Code | Code Description | Billed Amt |
| 99202 | Office/Outpatient Visit, New Patient ~ 15-29 Min | $391.38 |
| 99212 | Office/Outpatient Visit, New Patient ~ 30-44 Min | $306.02 |
| 99203 | Office/Outpatient Visit, New Patient ~ 45-59 Min | $609.51 |
| 99213 | Office/Outpatient Visit, Established Patient ~ May not require the presence of a physician or other qualified health care professional | $493.74 |
| 99204 | Office/Outpatient Visit, Established Patient ~ 10-19 Min | $915.64 |
| 99214 | Office/Outpatient Visit, Established Patient ~ 20-29 Min | $697.18 |
| 96138 | Brain Check | $64.80 |
| 62321 | Cervical ESI | $1,524.66 |
| 62323 | Lumbar ESI | $1,497.42 |
| 64479 | Cervical ESI (transform) | $1,878.42 |
| 64483 | Lumbar ESI (transform) | $1,880.16 |
| 20550 | Tendon Injection | $346.20 |
| 20551 | Inj Tendon Origin/Insert | $343.26 |
| 20553 | TPI (3 or more) | $360.18 |
| 20552 | TPI (1-2 muscles) | $312.96 |
| 20600 | Joint Injection | $535.90 |
| 20605 | Joint Injection W/O ultrasound | $548.80 |
| 20606 | Joint Injection WITH Ultrasound | $890.70 |
| 20610 | Joint Injection | $668.80 |
| 20611 | Drain/inj joint/bursa w/us | $983.90 |
| 27096 | SI Joint injection | $1,891.80 |
| 10140 | Drainage of a hematoma | $1,670.50 |
| 64405 | 3rd occipital nerve block | $982.00 |
| 64445 | nerve block Njx aa&/strd sciatic nerve | $1,541.70 |
| 64450 | Peripheral Nerve Blocks | $937.10 |
| 64490 | C MBB/Facet 1 level | $1,879.60 |
| 64491 | C MBB/Facet 2 level | $957.90 |
| 64492 | C MBB/Facet 3 level & additional | $961.00 |
| 64493 | L MBB/Facet 1 level | $1,724.40 |
| 64494 | L MBB/Facet 2 level | $891.70 |
| 64495 | L MBB/Facet 3 level & additional | $891.70 |
| 64447 | Njx aa&/strd femoral nerve | $1,135.00 |
| 64633 | C RFN 1 level | $4,237.10 |
| 64634 | C RFN 2 level & additional | $2,449.10 |
| 64635 | L RFN 1 level | $4,271.50 |
| 64636 | L RFN 2 level & additional | $2,295.40 |
| 64625 | SI RFN (1 level only) | $4,563.90 |
| 64999 | unlisted (price can vary) | (price can vary see estimate) |
| J7322 | Hymovis injection 1 | $4,560.48 |
| J7322 | Hymovis injection 2 | $9,120.96 |
| J0171 | Adrenaline | $14.80 |
| J1030 | 40 depo | $66.90 |
| J1040 | 80 depo | $129.60 |
| J2001 | lidocaine | $32.00 |
| J3490 | lidocaine patches | $55.00 |
| S0020 | bupivacaine | $7.30 |
| c9290 | bupivacaine liposome | $166.25 |
| Q9966 | omnupaque | $102.20 |
| J1100 | dexamethasone | $20.88 |
| J3301 | 3301 – kenalog | $100.00 |
| 99441 | Phone code 5-10 min | $282.12 |
| 99442 | Phone code 11-20 min | $357.12 |
| 99443 | Phone code 21-30 min | $507.04 |
| 90785 | Psytx complex interactive | $29.19 |
| 92548 | Balance | $591.96 |
| 92537 | Caloric (4) | $232.68 |
| 92538 | Caloric (2) | $131.46 |