Price Transparency Guide

Price Transparency Guide

updated September 6, 2024

 

Patient Financial Resources

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.

Request an Estimate

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