Visits & medical services prices at Indian Path Community Hospital

Kingsport, TN · every code in this section with a posted price and a Medicare benchmark.

283 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
Ablation av node (93650) $3,730.80 $24,872 0.5×
Aep hearing status deter broadband stimuli i&r (92651) $66.30 $442 0.3×
Aep threshold estimation mlt frequencies i&r (92652) $125.55 $837 0.6×
Airway inhalation treatment (94640) $79.42 $529.50 0.4×
Analyze neurostim no prog (95970) $54.75 $365 0.5×
Appl on-body injector for timed subq injection (96377) $27 $180 0.6×
Assessment of aphasia (96105) $98.70 $658 1.0×
Asstv Technol Assmt Dir Cntct W/Reprt Ea 15 Min (97755) $35.25 $235 0.9×
Behavioral and qualitative analysis of voice and resonance (92524) $92.55 $617 0.8×
Bfb training 1st 15 min (90912) $11.40 $76 0.1×
Bfb training ea addl 15 min (90913) $6.30 $42 0.2×
Biofeedback training any modality (90901) $38.85 $259 0.9×
Blink reflex test (95933) $66.15 $441 1.2×
Breath Hydrogen/Methane Test (91065) $69.45 $463 0.4×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $194.55 $1,297 0.6×
C motor evoked uppr limbs (95928) $413.85 $2,759 0.5×
C motor evoked upr&lwr limbs (95939) $347.85 $2,319 0.4×
Canalith Repositioning (95992) $42.30 $282 1.0×
Car seat/bed test 60 min (94780) $49.65 $331 1.5×
Cardiac Stress Tst,Tracing Only (93017) $223.95 $1,493 1.1×
Cardiopulmonary exercise testing (94621) $247.50 $1,650 0.7×
Cardiopulmonary resuscitation (92950) $513.90 $3,426 2.6×
Cardioversion (92960) $513.90 $3,426 0.9×
Caregiver training 1st 30 min (97550) $67.05 $447 1.3×
Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) $33.60 $224 1.3×
Cath Cath Place/Coronary Angio, Img Super/Interp, Bypass Angio (93455) $1,818.15 $12,121 0.6×
Cath Cath Place/Coronary Angio, Img Super/Interp,W Right Heart Cath (93456) $1,783.05 $11,887 0.6×
Cath Perc Clos,Cong Interatrial Commun W/Impl (93580)
likely a partial charge, not the full procedure
$3,076.95 $20,513 0.2×
Cath Place/Coron Angio, Img Super/Interp, Bypass Angio,W L Hrt Ventric (93459) $2,405.40 $16,036 0.8×
Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) $2,405.40 $16,036 0.8×
Cbt 1st hour (94644) $43.50 $290 0.4×
Chemo Admin Peritoneal Cavity (96446) $63.90 $426 0.2×
Chemo Hormon Antineopl Sq/Im (96402) $53.55 $357 0.8×
Chemo inj subarach/intravent (96542) $46.95 $313 0.2×
Chemo IV push addl drug (96411) $106.95 $713 1.6×
Chemo Iv Push Sngl Drug (96409) $184.05 $1,227 0.6×
Chemo prolong 8+ hrs infuse w/pump (96416) $279.90 $1,866 0.9×
Chemother, IV infusion, 1 hr (96413) $260.40 $1,736 0.9×
Chemother, IV infusion, ea add hr (96415) $58.95 $393 0.9×
Chemother,Ia Push Technique (96420) $296.25 $1,975 1.0×
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $88.05 $587 1.3×
Chemotherapy, unspecified procedure (96549) $16.95 $113 0.4×
Chemotx Admn Cns Req Spinal Puncture (96450) $221.55 $1,477 0.7×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $126.90 $846 1.9×
Color/duplex Doppler, complete (93975) $344.25 $2,295 1.6×
Color/duplex Doppler, limited (93976) $229.50 $1,530 2.4×
Cont Gluc Monitoring Patient Provided Equipment (95249) $33.90 $226 0.6×
Continuous Glucose Monitoring (95250) $94.35 $629 0.8×
Coronary artery angio s&i (93454) $1,818.15 $12,121 0.6×
Cortical mapping 1st hr (95961) $282.60 $1,884 0.4×
Cpap initiation and management (94660) $234.75 $1,565 1.2×
Cpt initial (94667) $38.85 $259 0.3×
Critical care (99291) $699.60 $4,664 0.9×
Ctr motor ep std transcrnl motor stimj lwr limbs (95929) $413.85 $2,759 1.2×
Debridement Open Wound 20 Sq Cm< (97597) $74.25 $495 0.4×
Demo &/or eval,pt use,aerosol device (94664) $34.80 $232 0.2×
Dermatological procedure (96999) $86.85 $579 0.5×
Developmental tst admin phys/qhp 1st hour (96112) $67.20 $448 0.6×
Dialysis other/than hemodialysis 1 phys/qhp eval (90945) $194.55 $1,297 0.5×
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $344.25 $2,295 1.6×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $229.50 $1,530 2.4×
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $344.25 $2,295 1.6×
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $229.50 $1,530 2.4×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $344.25 $2,295 1.6×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $229.50 $1,530 2.4×
Dup-scan xtr veins unilateral/limited study (93971) $229.50 $1,530 2.4×
Duplex hemodialysis access (93990) $229.50 $1,530 2.4×
Duplex scan artl infl&ven o/f hemo compl bi std (93985) $476.25 $3,175 2.2×
Duplex scan artl infl&ven o/f hemo compl uni std (93986) $317.55 $2,117 3.3×
Duplex scan extracranial art compl bi study (93880) $229.50 $1,530 1.1×
Echo Heart Xthoracic,Limited (93308) $175.35 $1,169 0.8×
Echo transesophageal (93312) $448.35 $2,989 0.9×
Echo Transesophageal - Congenital Tee Complete (93315) $293.10 $1,954 0.6×
Echo Transthoracic - Congenital Tte Complete (93303) $448.35 $2,989 0.9×
Echo Transthoracic - Congenital Tte Limited (93304) $209.55 $1,397 0.4×
EEG awake asleep (95819) $213.45 $1,423 1.1×
EEG awake drowsy (95816) $205.50 $1,370 1.0×
EEG cerebral death evaluation (95824) $184.80 $1,232 0.5×
EEG coma or sleep only (95822) $282.45 $1,883 1.4×
EEG cont rec w/video by tech min 8 channels (95700) $263.55 $1,757 1.3×
Eeg Extended Monitoring 61-119 Minutes (95813) $386.85 $2,579 2.0×
Eeg W/O Vid 2-12 Hr Unmntr (95705) $263.55 $1,757 1.3×
EEG w/o vid by tech ea incr 12-26 hr intmt mntr (95709) $241.05 $1,607 0.7×
EEG w/o vid by tech ea incr 12-26hr unmonitored (95708) $505.35 $3,369 1.5×
EEG w/o vid tech ea incr 12-26 hr cont r-t mntr (95710) $505.35 $3,369 1.5×
EEG w/o video by tech 2-12 hr intermittent mntr (95706) $289.80 $1,932 1.5×
EEG w/o video by tech 2-12hr continuous r-t mntr (95707) $318.75 $2,125 1.6×
EKG (93005) $70.95 $473 1.3×
Ekg Signal Averaging (93278) $58.50 $390 1.1×
Elec alys implt cplx cn npgt prgrmg (95977) $61.80 $412 0.7×
Elec alys nstim pls gen smpl sc/perph w/prgrmg (95971) $59.85 $399 0.7×
Electroencephalogram Extend Monitoring 41-60 Min (95812) $350.70 $2,338 1.8×
EMG cranial nerve bilat (95868) $69.15 $461 0.4×
EMG cranial nerve unilat (95867) $71.55 $477 0.4×
EMG four extremities (95864) $133.20 $888 1.1×
EMG one extremity (95860) $68.10 $454 0.6×
EMG three extremities (95863) $123.75 $825 1.1×
EMG two extremities (95861) $87.75 $585 0.7×
Ep & ablate supravent arrhyt (93653)
likely a partial charge, not the full procedure
$4,032.60 $26,884 0.2×
Ep & ablate ventric tachy (93654)
likely a partial charge, not the full procedure
$4,032.60 $26,884 0.2×
Ep Analyze Pacer Sys (93724) $513.90 $3,426 1.8×
Ep Compre Electrophysiologic Arrhythmia Induction (93620)
likely a partial charge, not the full procedure
$1,142.25 $7,615 0.2×
Ep Ephys Eval Pacg Cvdfb Prgrmg/Reprgrmg Parameters (93642) $513.90 $3,426 0.5×
Er level 1 (99281) $68.40 $456 0.9×
Er level ii (99282) $94.35 $629 0.7×
Er level iii (99283) $204.75 $1,365 0.8×
Er level IV (99284) $300.30 $2,002 0.8×
Er level v (99285) $456.15 $3,041 0.8×
Eval&/Fitg Voice Prostc Dev Suplmnt Oral Speec (92597) $70.50 $470 1.0×
Evaluation of speech fluency (92521) $110.10 $734 0.8×
Evaluation of speech sound production (92522) $89.85 $599 0.8×
Evaluation of swallowing function (92610) $82.20 $548 1.0×
Evaluation with prescription of speech-generating alternative (92607) $124.05 $827 1.0×
Evoked auditory test,limited (92587) $23.70 $158 0.1×
Exercise tst brncspsm (94617) $60.15 $401 0.5×
Exhaled Air Analysis (94690) $41.10 $274 0.8×
External ECG rec>48hr<7d recording (93242) $161.85 $1,079 4.8×
External ECG rec>7d<15d recording (93246) $161.85 $1,079 4.8×
External Ecg Scanning Analysis Report (93226) $247.50 $1,650 4.6×
Flexible Endoscopic Eval Swallow C/V Rec (92612) $167.10 $1,114 0.8×
Flow volume loop (94375) $92.25 $615 0.5×
Fundus photography w/interpretation & report (92250) $54.75 $365 0.5×
Group Therapeutic Procedures (97150) $16.80 $112 0.9×
Hemodialysis (90935) $301.05 $2,007 0.5×
Holter Monitor Recording (93225) $247.50 $1,650 2.1×
Imm Admn Sarscov2 Vaccine Single Dose (90480) $17.85 $119 0.5×
Immunization Admin (90471) $25.50 $170 0.4×
Immunotherapy, 2+ Injections (95117) $12.90 $86 0.3×
Inhlj Brncl Challenge Tstg W/Histamine/Methachol (95070) $106.35 $709 0.3×
Injection intra arterial (96373) $53.70 $358 0.3×
Ins swan ganz bedside (93503) $1,818.15 $12,121 1.3×
Interrog dev eval scrms phys/qhp in person (93291) $513.90 $3,426 19.6×
Interrog&prgrmg impl phrenic nrv stimulator sys (93151) $47.55 $317 0.6×
Interrog&prgrmg ipnss during polysomnography (93152) $147 $980 0.5×
Interrogation without programming ipnss (93153) $147 $980 1.7×
Intralesional Chemo Admin,8+ Lesn (96406) $43.20 $288 0.2×
Irrigaj Implntd Venous Access Drug Delivery Syst (96523) $29.40 $196 0.5×
Ischemic limb exercise test (95875) $101.40 $676 0.9×
IV infusion hydration each additional hour (96361) $27.60 $184 0.6×
IV infusion hydration initial 31 min-1 hour (96360) $79.95 $533 0.4×
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $43.95 $293 0.7×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $92.55 $617 0.5×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $36 $240 0.8×
IV push initial (96374) $59.70 $398 0.3×
Manual therapy 15 min (97140) $28.95 $193 1.0×
Massage 15 min (97124) $25.35 $169 0.9×
Maximum voluntary ventilation (94200) $28.95 $193 0.5×
Mechanical traction (97012) $20.10 $134 1.4×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $12 $80 0.4×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $15.75 $105 0.4×
Methacholine challenge (94070) $229.20 $1,528 0.7×
Mnt Group Ea 30 Min (97804) $5.25 $35 0.3×
Motility study esophagus (91010) $227.25 $1,515 0.7×
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $83.70 $558 0.9×
Multiple sleep latency test (95805) $338.40 $2,256 0.4×
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $71.85 $479 0.6×
Neg press wnd tx </=50 sq cm (97607) $75.45 $503 0.2×
Neg press wound tx >50 cm (97608) $75.45 $503 0.2×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $39.15 $261 0.2×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $54.30 $362 0.1×
Nerve conduction studies 13/> studies (95913) $76.05 $507 0.2×
Nerve Conduction Studies 3-4 Studies (95908) $46.95 $313 0.2×
Nerve Conduction Studies 9-10 Studies (95911) $62.85 $419 0.2×
Nerve conduction studies; 1-2 studies (95907) $42.75 $285 0.2×
Nerve conduction studies; 11-12 studies (95912) $69.15 $461 0.2×
Nerve conduction studies; 5-6 studies (95909) $51.75 $345 0.3×
Nerve conduction studies; 7-8 studies (95910) $57 $380 0.2×
Neurobehavioral Status Exam (96116) $128.40 $856 0.7×
Neuromuscular junction test (95937) $54.30 $362 0.5×
Newborn resuscitation (99465) $130.20 $868 0.2×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $229.50 $1,530 1.9×
Non-Invasive Physiologic Study Extremity 3 Levls (93923) $252.45 $1,683 1.3×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $69.15 $461 0.6×
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $36.60 $244 0.8×
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $29.25 $195 0.9×
Ot Contrast Bath Ea 15 Min (97034) $17.40 $116 1.2×
Ot eval high complex 60 min (97167) $79.20 $528 0.8×
Ot eval low complex 30 min (97165) $71.70 $478 0.7×
Ot eval mod complex 45 min (97166) $75.45 $503 0.8×
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $46.20 $308 0.9×
Ot Prosthetic Training, Each 15 Min (97761) $31.95 $213 0.8×
Ot Range Motion Measure,Each Extrem (95851) $16.80 $112 0.6×
Ot re-eval est plan care (97168) $45.90 $306 0.7×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $25.35 $169 0.2×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $49.20 $328 0.4×
Paraffin bath (97018) $18.75 $125 3.1×
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $53.55 $357 0.3×
Peripheral arterial disease rehab per session (93668) $513.90 $3,426 9.6×
Phy/qhp op pulm rhb w/mntr (94626) $38.10 $254 0.7×
Phy/qhp op pulm rhb w/o mntr (94625) $35.85 $239 0.7×
Plethysmography (94726) $92.40 $616 0.3×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $555.60 $3,704 0.7×
Polysom <6 yrs 4/> paramtrs (95782) $933.60 $6,224 1.2×
Polysom <6 Yrs Sleep W/Cpap/Bilvl Vent 4/> Param (95783) $972.45 $6,483 1.2×
Polysom Any Age Sleep Stage 1-3 Addl Param Attnd (95808) $512.85 $3,419 0.7×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $6 $40 0.1×
Prq balloon valvuloplasty aortic valve (92986) $4,357.65 $29,051 0.8×
Prq card revasc chronic 1vsl (92943)
unusually low: confirm this is the full procedure
$4,357.65 $29,051 0.4×
Prq Card Stent W/Angio 1 Vsl (92928)
unusually low: confirm this is the full procedure
$3,339.75 $22,265 0.3×
Prq Card Stent/Ath/Angio (92933)
likely a partial charge, not the full procedure
$3,339.75 $22,265 0.2×
Prq revasc byp graft 1 vsl (92937)
unusually low: confirm this is the full procedure
$4,357.65 $29,051 0.4×
Prq trluml coronary angio/atherect one art/brnch (92924)
unusually low: confirm this is the full procedure
$4,357.65 $29,051 0.4×
Prq trluml coronary angioplasty one art/branch (92920) $4,357.65 $29,051 0.8×
Psycl/nrpsycl tst tech 2+ tst 1st 30 min (96138) $163.50 $1,090 0.4×
Pt Aquatic Therapy/Exercises (97113) $40.95 $273 1.1×
Pt Electric Current Therapy (97033) $28.20 $188 1.5×
Pt Electrical Stimulation (97032) $18.45 $123 1.3×
Pt eval high complex 45 min (97163) $81.75 $545 0.8×
Pt eval low complex 20 min (97161) $73.80 $492 0.8×
Pt Gait Training Therapy (97116) $27.45 $183 0.9×
Pt Infrared Therapy (97026) $17.70 $118 2.6×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $32.25 $215 1.0×
Pt Physical Performance Test (97750) $31.95 $213 0.9×
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $77.85 $519 0.8×
Pt re-evaluation (97164) $48.60 $324 0.7×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $33.60 $224 1.0×
Pt Ultrasound Therapy (97035) $16.35 $109 1.1×
Pt Whirlpool Therapy (97022) $22.05 $147 1.4×
Pulm Funct Test Oscillometry (94728) $42.90 $286 0.4×
Pulm function test by gas (94727) $47.55 $317 0.2×
Pulmonary stress testing (94618) $91.80 $612 0.8×
R & l hrt cath w/njx l ventriculog img s&i (93453) $2,576.70 $17,178 0.9×
R & L Hrt Cath Winjx Hrt Art& L Ventr Img (93460) $2,576.70 $17,178 0.9×
R hrt art/grft angio (93457) $2,405.40 $16,036 0.8×
R& L Hrt Cath W/Injec Hrt Art/Grft& L Vent I (93461) $2,576.70 $17,178 0.9×
Refill/maint, portable pump (96521) $160.65 $1,071 0.8×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $247.50 $1,650 7.3×
Remote dx retinal imaging (92227) $25.05 $167 0.5×
Right heart cath (93451) $2,405.40 $16,036 0.8×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $84 $560 0.5×
Rt Chest Wall Manipulation,Subsequent (94668) $28.95 $193 0.2×
Rx/Physical Eeg Activaj Phys/Qhp Attendance (95954) $232.95 $1,553 0.7×
Sc Ther Infusion Reset Pump (96371) $37.80 $252 0.6×
Sensory Integration Ea 15 Min (97533) $28.35 $189 0.5×
Short-latency somatosens ep std lwr limbs (95926) $109.65 $731 0.6×
Short-latency somatosens ep std upr limbs (95925) $365.55 $2,437 1.9×
Sleep study attended (95807) $520.05 $3,467 1.5×
Sleep study unattended (95806) $260.70 $1,738 1.3×
Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) $184.80 $1,232 0.9×
Slp stdy unatnd w/min hrt rate/o2 sat/resp anal (95801) $161.70 $1,078 3.0×
Somatosensory testing (95938) $272.25 $1,815 0.3×
Speech group therapy (92508) $22.65 $151 0.9×
Speech sound lang comprehen (92523) $185.85 $1,239 0.8×
Spirometry (94010) $86.40 $576 0.4×
Standardized Cognitive Performance Testing (96125) $46.05 $307 0.4×
Stress echo (93350) $448.35 $2,989 0.9×
Stress Tte Complete (93351) $448.35 $2,989 0.9×
Subcut infusion, therap/proph/diagnost,ea add hour (96370) $323.25 $2,155 7.6×
Subcut infusion, therap/proph/diagnost,initial,1st hour (96369) $77.40 $516 0.4×
Surfactant Admin Thru Tube (94610) $58.65 $391 0.3×
Temp transcutaneous pacing (92953) $513.90 $3,426 0.9×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $23.70 $158 1.1×
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $22.65 $151 1.1×
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $107.10 $714 1.0×
Ther/prop/diag inj/inf proc (96379) $19.35 $129 0.5×
Ther/Proph/Diag Inj Sc/Im (96372) $31.95 $213 0.5×
Therapeutic Activities (97530) $33.60 $224 1.0×
Therapeutic phlebotomy (99195) $65.10 $434 0.5×
Tilt Table Eval (93660) $450.75 $3,005 1.3×
Transcran Doppler Intracran Art - Transcranial Doppler (93886) $317.55 $2,117 1.5×
Transcranial Doppler Limited (93888) $229.50 $1,530 2.4×
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $448.35 $2,989 0.9×
Tte W/O Doppler Complete - Tte Complete No Doppler No Color (93307) $306.45 $2,043 1.4×
Tx atrial fib pulm vein isol (93656)
likely a partial charge, not the full procedure
$4,032.60 $26,884 0.2×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $77.40 $516 1.0×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $84 $560 1.0×
Tx/Pro/Dx Inj New Drug Addon (96375) $27.75 $185 0.7×
Unlisted pulmonary service/procedure (94799) $21.60 $144 0.2×
Vasc Duplex Extrem Venous,Bilat (93970) $344.25 $2,295 1.6×
Vasc Duplex Scan Extracranial,Limited (93882) $229.50 $1,530 2.4×
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $229.50 $1,530 1.2×
Vasopneumatic device (97016) $25.20 $168 2.1×
Veeg by tech 2-12 hours unmonitored (95711) $263.55 $1,757 1.3×
Veeg by tech 2-12 hr continuous r-t monitoring (95713) $505.35 $3,369 1.5×
Veeg by tech 2-12 hr intermittent monitoring (95712) $289.80 $1,932 0.9×
Veeg by tech ea incr 12-26 hr cont r-t mntr (95716) $945.90 $6,306 1.2×
Veeg by tech ea incr 12-26 hr intermittent mntr (95715) $556.05 $3,707 1.6×
Veeg Ea 12-26 Hr Unmntr (95714) $505.35 $3,369 1.5×
Ventilation assist & mgmt inpatient 1st day (94002) $198.90 $1,326 0.4×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $405.60 $2,704 0.7×
Visual Evoked Potential Test (95930) $107.70 $718 0.5×
Vital capacity total (94150) $28.35 $189 0.2×
Wheelchair Mgmt Ea 15 Min (97542) $29.55 $197 1.0×