Referral Services: Fees & Services

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
30^o Posterior Oblique
60^o 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 – 15^o Cephalad
AP – 15^o 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