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Inside X-Rays

X-Ray Fee Schedule

CPT

 Fee

TOS

Radiology

72040

 $  95

 $    71

Spine, cervical; two or three views

72050

 $197

 $  148

Spine, cervical; minimum of four views

72052

 $169

 $  126

Spine, cervical; complete, including oblique and flexion and/or extension

72070

 $105

 $    79

Spine, thoracic; two views

72080

 $115

 $    86

Spine, thoracolumbar; two views

72100

 $116

 $    87

Spine, lumbosacral; two or three views

72110

 $219

 $  164

Spine, lumbosacral; minimum of four views

72114

 $257

 $  193

Spine, lumbosacral; complete, including bending views

72120

 $153

 $  115

Spine, lumbosacral, bending views only, minimum of 4 views

72170

 $  97

 $    73

Pelvis; one or two views

73030

 $110

 $    82

Shoulder; complete, minimum of two views

73070

 $  72

 $    54

Elbow; two views

73080

 $103

 $    78

Elbow; complete, minimum of three view

73100

 $  73

 $    55

Wrist; two views

73110

 $103

 $    77

Wrist; complete, minimum of three views

73120

 $  70

 $    53

Hand; two views

73130

 $103

 $    77

Hand: minimum of three views

73510

 $120

 $    90

Hip, unilateral, complete, minimum of two views

73520

 $167

 $  125

Hips, bilateral, minimum of two view of each hip, including AP view of pelvis

73560

 $  79

 $    59

Knee; one or two views

73562

 $104

 $    78

Knee; three views

73564

 $  86

 $    65

Knee; complete, four or more views

73600

 $  66

 $    50

Ankle; 2 views

73610

 $110

 $    82

Ankle; complete, minimum of three views

73620

 $  66

 $    50

Foot; two views

73630

 $104

 $    78

Foot; complete,  minimum of three views

Fee = Regular Fee

TOS = Payment at Time Of Service (Available to all)

 

 
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