|
TYPE OF RADIOGRAPH
|
TOTAL COST
|
TECHNICAL FEE
|
INTERP FEE
|
CPT CODE
|
|
X-Ray Copies
8 x 10
10 x 12
14 x 17
|
$5 each
$6 each
$9 each
|
|
|
76499
76499
76499
|
|
MRI/CT/Ultrasound (Interpretation Only)
|
|
|
$50
|
|
|
Lumbar Spine, Three Views
AP
Lateral
AP Ferguson
|
$105
|
$73.50
$24.50
$24.50
$24.50
|
$31.50
$10.50
$10.50
$10.50
|
72100
72020
72020
72020
|
|
Lumbar Spine, Five Views
AP
Lateral
AP Ferguson
Right Oblique
Left Oblique
|
$175
|
$122.50
$24.50
$24.50
$24.50
$24.50
$24.50
|
$52.50
$10.50
$10.50
$10.50
$10.50
$10.50
|
72110
72020
72020
72020
72020
72020
|
|
Lumbar Spine, Seven Views
AP
Lateral
AP Ferguson
Right Oblique
Left Oblique
Traction
Compression
|
$245
|
$171.50
$24.50
$24.50
$24.50
$24.50
$24.50
$24.50
$24.50
|
$73.50
$10.50
$10.50
$10.50
$10.50
$10.50
$10.50
$10.50
|
72110-22
72020
72020
72020
72020
72020
72020
72020
|
|
Lumbar Spine, Seven Views
AP
Lateral
AP Ferguson
Right Oblique
Left Oblique
Right Lateral Bending
Left Lateral Bending
|
$245
|
$171.50
$24.50
$24.50
$24.50
$24.50
$24.50
$24.50
$24.50
|
$73.50
$10.50
$10.50
$10.50
$10.50
$10.50
$10.50
$10.50
|
72114
72020
72020
72020
72020
72020
72020
72020
|
|
Lumbar Spine
Right Oblique
Left Oblique
|
$70
|
$49
$24.50
$24.50
|
$21
$10.50
$10.50
|
72100
|
|
Lumbar Spine
Right Kovacs View
Left Kovacs View
|
$70
|
$49
$24.50
$24.50
|
$21
$10.50
$10.50
|
72100
72020
72020
|
|
Cervical Spine, Three Views
AP Lower Cervical
AP Open Mouth
Lateral
|
$90
|
$63
$21
$21
$21
|
$27
$9
$9
$9
|
72040
72020
72020
72020
|
|
Cervical Spine, 5 Views
AP Lower Cervical
AP Open Mouth
Lateral
Right Oblique
Left Oblique
|
$150
|
$105
$21
$21
$21
$21
$21
|
$45
$9
$9
$9
$9
$9
|
72050
72020
72020
72020
72020
72020
|
|
Cervical Spine, Sevem Views
AP Lower Cervical
AP Open Mouth
Lateral
Right Oblique
Left Oblique
Flexion
Extension
|
$210
|
$147
$21
$21
$21
$21
$21
$21
$21
|
$63
$9
$9
$9
$9
$9
$9
$9
|
72052
72020
72020
72020
72020
72020
72020
72020
|
|
Cervical Spine
Right Oblique
Left Oblique
|
$60
|
$42
$21
$21
|
$18
$9
$9
|
72040
72020
72020
|
|
Cervical Spine
Flexion
Extension
|
$60
|
$42
$21
$21
|
$18
$9
$9
|
72040
72020
72020
|
|
Cervical Spine
Right Pillar View
Left Pillar View
|
$60
|
$42
$21
$21
|
$18
$9
$9
|
72040
72020
72020
|
|
Swimmers View
|
$30
|
$21
|
$9
|
72020
|
|
Thoracic Spine, two Views
AP
Lateral
|
$70
|
$49
$24.50
$24.50
|
$21
$10.50
$10.50
|
72070
72020
72020
|
|
PA Chest
|
$35
|
$24.50
|
$10.50
|
71010
|
|
Apical Lordotic Chest View
|
$35
|
$24.50
|
$10.50
|
71021
|
|
Chest Series, Two Views
PA Chest
Lateral Chest
|
$70
|
$49
$24.50
$24.50
|
$21
$10.50
$10.50
|
71020
71010
|
|
Rib Series
AP
30o Posterior Oblique
60o Posterior Oblique
AP of Ribs 10-12
PA Chest, Expiratory
|
$175
|
$122.50
$24.50
$24.50
$24.50
$24.50
$24.50
|
$52.50
$10.50
$10.50
$10.50
$10.50
$10.50
|
71111
71010
|
|
Sternum Series
Lateral
RAO
|
$64
|
$44
$22
$22
|
$20
$10
$10
|
71120
|
|
Full Spine Series
AP
Lateral
|
$81
|
$56.70
$28.35
$28.35
|
$24.30
$12.15
$12.15
|
72010
72020
72020
|
|
Scoliosis Series
FSAP
FSL
Recumbent AP of Curvature
Recumbent AP Forced Right Bend
Recumbent AP Forced Left Bend
PA Left Hand
|
$221
|
$154.70
$28.35
$28.35
$24.50
$24.50
$24.50
$24.50
|
$66.30
$12.15
$12.15
$10.50
$10.50
$10.50
$10.50
|
2090
72020
72020
|
|
Clavicle Series
PA Straight
AP Tangential
|
$64
|
$44
$22
$22
|
$20
$10
$10
|
73000
|
|
Shoulder Series
Internal Rotation
External Rotation
Baby Arm
|
$92
|
$64
$21
$21
$22
|
$28
$9
$9
$10
|
73030
73020
73020
73020
|
|
Acromioclavicular Joint Series
Bilateral AP Non-Weighted
Bilateral AP Weighted
|
$128
|
$88
$44
$44
|
$40
$20
$20
|
73050
|
|
Scapula Series
AP
Oblique (Tangential)
|
$64
|
$44
$22
$22
|
$20
$10
$10
|
73010
|
|
Humerus Series
AP Entire
Lateral Entire
|
$70
|
$49
$24.50
$24.50
|
$21
$10.50
$10.50
|
73060
|
|
Forearm Series
AP Entire
Lateral Entire
|
$66
|
$46
$23
$23
|
$20
$10
$10
|
73090
|
|
Elbow Series
AP
Lateral
Jones (Acute Flexion)
Medial Oblique
|
$120
|
$84
$21
$21
$21
$21
|
$36
$9
$9
$9
$9
|
73080
|
|
Wrist Series
PA Wrist
Lateral
Oblique (Pronated)
PA with Ulnar Deviation
|
$120
|
$84
$21
$21
$21
$21
|
$36
$9
$9
$9
$9
|
73110
|
|
Carpal View
|
$30
|
$21
|
$9
|
|
|
Hand Series
PA Hand
Oblique
Lateral
|
$90
|
$63
$21
$21
$21
|
$27
$9
$9
$9
|
73130
|
|
Finger Series
PA (Entire Hand)
Oblique/Lateral Affected Finger
|
$62
|
$43
$21
$22
|
$19
$9
$10
|
73140
|
|
Hip Series
AP Pelvis
AP Spot Hip
Lateral Hip
|
$99
|
$68.50
$24.50
$22
$22
|
$30.50
$10.50
$10
$10
|
73510
72170
73500
73500
|
|
Bilateral Hip Series
AP Pelvis
R/L AP Spot Hip
R/L Lateral Hip
|
$163
|
$112.50
$24.50
$44
$44
|
$50.50
$10.50
$20
$20
|
73520
72170
|
|
Bilateral Hips (Small Children Only)
AP Pelvis (Internally Rotated)
AP Pelvis (Bilateral Frog Leg)
|
$66
|
$46
$23
$23
|
$20
$10
$10
|
73540
|
|
AP Pelvis
|
$35
|
$24.50
|
$10.50
|
72170
|
|
Sacrum and Coccyx Series
AP – 15o Cephalad
AP – 15o Caudad
Lateral
|
$97.50
|
$66
$22
$22
$22
|
$31.50
$10.50
$10.50
$10.50
|
72220
|
|
Sacroiliac Joint Series
AP Ferguson
Right Posterior Oblique
Left Posterior Oblique
|
$99
|
$68.50
$24.50
$22
$22
|
$30.50
$10.50
$10
$10
|
72202
|
|
Femur Series
AP Entire (Bucky Only)
Lateral (Including Knee)
Lateral Hip
|
$102
|
$71
$24.50
$24.50
$22
|
$31
$10.50
$10.50
$10
|
73550
|
|
Tibia and Fibula Series
AP Entire
Lateral Entire
|
$70.
|
$49
$24.50
$24.50
|
$21
$10.50
$10.50
|
73590
|
|
Knee Series
AP
Lateral
Tangential Patella
Tunnel
|
$120
|
$84
$21
$21
$21
$21
|
$36
$9
$9
$9
$9
|
73564
73560
73560
73560
73560
|
|
Knee – R/L Obliques (On Request Only)
|
$60
|
$42
|
$18
|
73560
|
|
Ankle Series
AP
Lateral
Internal Oblique
|
$90
|
$63
$21
$21
$21
|
$27
$9
$9
$9
|
73610
|
|
Ankle Series with Stress
|
$30
|
$21
|
$9
|
|
|
Foot Series
AP
Lateral
Medial Oblique
|
$90
|
$63
$21
$21
$21
|
$27
$9
$9
$9
|
73630
|
|
Calcaneal Series
Lateral
Tangential
|
$60
|
$42
$21
$21
|
$18
$9
$9
|
73650
|
|
Toe Series
AP Foot
Lateral / Oblique Toe
|
$62
|
$43
$21
$22
|
$19
$9
$10
|
73660
|
|
Leg Length (Scan-O-Gram)
Right: AP Hip, AP Knee, AP Ankle
Left: AP Hip, AP Knee, AP Ankle
|
$70
|
$49
$24.50
$24.50
|
$21
$10.50
$10.50
|
76040
|
|
KUB (Kidney, Ureter, Bladder)
AP Supine
Lateral for Kidney Stone/Aorta
|
$70
|
$49
$24.50
$24.50
|
$21
$10.50
$10.50
|
74020
74000
|
|
Obstruction Series
AP Supine
Lateral
AP Upright w/Diaphragms
PA Chest
|
$140
|
$98
$24.50
$24.50
$24.50
$24.50
|
$42
$10.50
$10.50
$10.50
$10.50
|
74022
|
|
Skull Series
Townes
PA
Right Lateral
Left Lateral
|
$128
|
$88
$22
$22
$22
$22
|
$40
$10
$10
$10
$10
|
70260
|
|
Nasal Bone Series
Waters
Right Lateral
Left Lateral
|
$90
|
$63
$21
$21
$21
|
$27
$9
$9
$9
|
70160
|
|
Sinus Series
Caldwell
Waters
Lateral
|
$90
|
$63
$21
$21
$21
|
$27
$9
$9
$9
|
70220
|
|
Temperomandibular Joint (TMJ)
R/L Open
R/L Closed
|
$60
|
$42
$21
$21
|
$18
$9
$9
|
70330
|
|
Mandible Series
Townes
PA
Right Oblique
Left Oblique
|
$128
|
$88
$22
$22
$22
$22
|
$40
$10
$10
$10
$10
|
70110
|
|
Metastatic Skeletal Survey
R/L AP Humerus
R/L Lateral Humerus
R/L AP Forearm
R/L Lateral Forearm
R/L AP Femur
R/L Lateral Femur
R/L AP Tib/Fib
R/L Lateral Tib/Fib
AP Pelvis
|
$315
|
$220.50
$24.50
$24.50
$24.50
$24.50
$24.50
$24.50
$24.50
$24.50
$24.50
|
$94.50
$10.50
$10.50
$10.50
$10.50
$10.50
$10.50
$10.50
$10.50
$10.50
|
6061
|