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Days	BS Description E	ICD	IOS BS	CPT	PACKAGE	Price
0	AUDIOMETRY	11306-00[1843]	360024	1130600	Y	150
0	AUDITORY STUDY STATE RESPONSE (ASSR)		360025	92589		480
0	AURAL POLYPECTOMY	41506-001	360026			1,600.00
0	AURAL REHAB FOLLOWING COCHLEAR IMPLANT(INCLUDES EVAL. OF AURAL REHAB STATUS & HEARING,THERAPEUTIC SERVICES WITH OR W/O SPEECH PROCESSOR PROG)HOUR - 2 UNITS(30		360027	92510		160
	MINUTES)
0	AURAL REHAB FOLLOWING COCHLEAR IMPLANT(INCLUDES EVAL. OF AURAL REHAB, STATUS & HEARING,THERAPEUTIC SERVICES WITH OR W/O SPEECH PROCESSOR PROG.) HOUR- 3 UNITS(45		360028	92510		240
	MINUTES)
0	AURAL REHAB. FOLLOWING COCHLEAR IMPLANT(INCLUDES EVAL. OF AURAL REHAB STATUS & HEARING, THERAPEUTIC SERVICES WITH OR W/O		360029	92510		80
	SPEECH PROCESSOR PROG)HOUR -1 UNIT(15 MIN.)
0	AURAL REHABILITATION FOLLOWING COCHLEAR IMPLANT ( INCLUDES AURAL REHABILITATION STATUS AND HEARING,THERAPEUTIC SERVICES WITH OR WITHOUT SPEECH PROCESSOR PROGRAMMING ) HOUR .		360030	92510		280
0	BIL INTRANASAL ANTRSTOMY-LASER	41716-021	360031			4,000.00
0	BIL. NASAL POLYPECTOMY (LASER)	41668-00	360032			5,500.00

Price List

AUDIOMETRY

150

AUDITORY STUDY STATE RESPONSE (ASSR)

480

AURAL POLYPECTOMY

1,600.00

AURAL REHAB FOLLOWING COCHLEAR IMPLANT(INCLUDES EVAL. OF AURAL REHAB STATUS & HEARING,THERAPEUTIC SERVICES WITH OR W/O SPEECH PROCESSOR PROG)HOUR - 2 UNITS(30

160

MINUTES)

AURAL REHAB FOLLOWING COCHLEAR IMPLANT(INCLUDES EVAL. OF AURAL REHAB, STATUS & HEARING,THERAPEUTIC SERVICES WITH OR W/O SPEECH PROCESSOR PROG.) HOUR- 3 UNITS(45

240

MINUTES)

AURAL REHAB. FOLLOWING COCHLEAR IMPLANT(INCLUDES EVAL. OF AURAL REHAB STATUS & HEARING, THERAPEUTIC SERVICES WITH OR W/O

SPEECH PROCESSOR PROG)HOUR -1 UNIT(15 MIN.)

AURAL REHABILITATION FOLLOWING COCHLEAR IMPLANT ( INCLUDES AURAL REHABILITATION STATUS AND HEARING,THERAPEUTIC SERVICES WITH OR WITHOUT SPEECH PROCESSOR PROGRAMMING ) HOUR .

280

BIL INTRANASAL ANTRSTOMY-LASER

4,000.00

BIL. NASAL POLYPECTOMY (LASER)

5,500.00

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