99201 Limited Initial Exam 40 L0510 Lumbosacr Support 45 Lab
A4570 Shou Sling, Swath 25 81000 Urinalysis 24.20
99202 Expanded Initial Exam 50 99070 Mineral Ice 4 oz. 5 80061 Chol/HDL 63
99203 Detailed Initial Exam 75 99070 Mineral Ice 16 oz. 14 82985 Glycated Protein 68
99204 Comprehensive Initial Exam 100 E0943 Tri-Core Reg Pillow 45 82523 NTX 83
99205 Complex Initial Exam 200 E0943 Tri-Core Youth Pillow 36.50
99205-21 Compl Init Ex/Reprt 350 E0943 Tri-Core Travel Pillow 23
A4570 Wrist Cock-Up Spint 28
99211 Brief Re-Eval 30 Electrical Pads Video Rentals
99212 Limited Re-Eval 40 E1399 Teaming Up
99213 Expand Re-Eval 55 E1399 Disease Toxicity
99214 Detailed Re-Eval 70 Xray E1399 Digestion Toxicity
99215 Compre Re-Eval 100 E1399 Diet Health
SMST Set Up 100 73600 Ankle, Limited 45 E1399 Mind Body
99215-21 Complex Re-Eval 150 73610 Ankle, Complete 55
99215-21 Complex Re-Eval 200 72050 Cervical, Limited 4V 75 Tape Rentals
99244 Compre P & S 159.45 72040 Cervical, AP Lat 60 E1399 Inner Smile 3
72052 Cervical, Complete 150 E1399 Journey to Health 3
72052 Cervical 5 View 225 E1399 Letting Go Stress 3
Health Club Visit 71010 Chest, 1 view 40 E1399 New Physics Healing 3
98940 Manip 1-2 Areas 29.12/40 71020 Chest, 2 view 60 E1399 Seven Habits 5
98941 Manip 3-4 Areas 36.54/60 73070 Elbow, Limited 45 E1399 First Thing 5
98942 Manip 5 Areas 37.74/75 73620 Foot, Limited 45 E1399 Principle Centered 5
97260 WC Manip 32.60 73140 Finger(s) 2 view 45 E1399 Take Charge Health
97261 Additional Area 22.14 73520 Hip, Bilat W/Pelvis 70
73120 Hand Limited 45
97124 Massage 30 min 35 73560 Knee, Limited 2 View 30
97124 Massage 60 min 70 73564 Knee, w/Tunnel Pat. 70 Books & Tapes
97039 G5 Mechanical Massage 20 72100 Lumbosacr, AP/LAT 75 (Purchase)
97112 Scoliosis Occulr Vest 20 72110 Lumbos, Complete 150
97265 Scoliosis Center Man 21 72114 Lumbos, W/Bending/Spot 200
71100 Ribs, Unilat 2 View 55 99071 Education Found 2.25
97012 Scol Fex/Distract 21 72070 Thoracic, Ltd AP/LAT 65 99071 Infant Nutrition 12.75
97014 Scol Muscle Stim 20 73020 Shoulder, Limited 45 E1399 Take Charge Health 8.25
97014-22 Scol Muscle Stim/Bio 20 73100 Wrist, Limited 45 99071 Take Charge Tape23.25
98941 OV-M-SCM-I-FD 102 99213 Review Outside Xray ___ 99071 Functional Dietic 22.50
98942 OV-M-SCM-1+2-FD 122 72020 Entire Spine, Single View 80 99071 Guilt Free Indulg 20.25
98943 OV-M-SCM-1+2-FD-NR 142 72010 Entire Spine, AP/LAT 120 99071 Teaming Up Book 5.25
99071 Pep Binder Set Ups 7.50 Add'l Xray______99071 Choosing Health 4.50
97110 Therapeutic Exercises 35 99071 Exercises Phase 1 51
97250 Myofascial Release 44.28/22.14 Biomarkers 99071 Exercises Phase 2 51
97139 Trigger Point 25 16 Biomarkers W/Lab 648 99071 Mind Body Conn 23.25
97122 Traction Flex/Distr 21 Wellness & Long 550 80019 Grt Smokies______
97012 Traction Interseg 20 Body Composition 15 99080 Copy Records Fee
97012 Traction Cervical 20 Lab/Bio 98 HAQ Received
97012 Traction Lumbar 20 Lab/NTX 150
97010 Hot/Cold Packs 20 93720 Plethysmography 163
97014 Electric Muscle Stim 20 97750 Cardiac Functionality 68 15min Wellness Class $5 Dated______
97014 Interfer Muscle Stim 20
97024 Diathermy 30
97032 Manual Elect Stim 25 99211 Nutrition Consult Pharmacy $______
97033 Iontophoresis 22
97035 Ultrasound 25 Patient______# ______Date:______
97035 Ultrasound w Muscle Stim 30 MO
29799 Orthot Foot Casting/Braces 100 Next Appt: M T W TH F _____ X _____ Wks
29240 Taping Shoulder 30 +10 +20 +30 +40 +50 +60 Re-Exam ROF
29540 Taping Ankle 30
L0120 Cervical Collar 20 PT ARCON CPT NUTR Casting: FT. COPES
E0943 Cervical Pillow 40 M T W TH F
E0943 Petite Cerv Pillow 36 +10 +20 +30 +40 +50 +60
L4350 Ankle Aircast 63
A4460 Elast Bandage/tube 10 MO
L1800 Knee Supp, Neoprene 30 Massage M T W TH F_____ X _____ Wks A9300 Exercise Tubing 10
E0993 Lumbar Pad 23 MO
E0992 LumbarLarge 25 Rehab M T W TH F _____ X _____ Wks
L3420 Foot Ortho FM Cast 300
L3350 Heel Elavatn TPRD 5/2 Comments______
E0230 Ice Blanket, Cerv 15
______
Charges:______Pmts:______C CH CC Adj______