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�6 <br /> ORANGE FAMILY MEDICAL GROUP PA <br /> 36/15/93 PROCEDURE FEES PAGE 7 <br /> PROCEDURE DESCRIPTION ALT. DESC. DEPT T.O.S. STD. FEE <br /> ------------------------------------------------------------------------------------------------------------------------------------ <br /> '4000 XRAY ABDOMEN 1 VIEW (XUB) XUB XR 0 16.00 <br /> '.1 0 XR4Y,RTBS,8ILAT. 6 VIEWS W/INTREPRET. XR XR 31 80.00 <br /> XRAY STERNUM, 3 VIEWS W/INTERPRET XR XR 31 .00 <br /> 214 SPAY PELVIS 3 SAT H*P, 2 V. WiINT_RPPET. %R XR 31 .00 <br /> _42 XRAY 1007, 2 VIEWS W/INTERPRET XR XR 31 .00 <br /> XPAY CERVICAL SPINE,4-5 V W/INTERPRET XR XR 31 .00 <br /> '0220 SINUS SERIES XR 0 .00 <br /> ^a0 XRAY,,.^ERV,CAL SPINE, 2 VIEWS W INTERPRET XR XR 0 19.00 <br /> 2-7 XRAY SACRUM & COCCYX W/INTERPRETATION XR XR 31 .00 <br /> 241 XRAY ANKLE 3 VIEWS/W/INTERPRET. XR XR 31 .00 <br /> 202 XRAY RIBS,BILAT. 6 VIEWS W/INTERPRET XR XR 31 .00 <br /> 254 TENP.NANDISULAR JOINT,UNILAT 4 V W%INTER XR XR 31 .00 <br /> XRAY A8DOMEN,2 V W/PA CHEST & INTERPRET XR XR 31 .00 <br /> X.RAY,PELVIS AP W/,NTERPRETATION XR XR 31 .00 <br /> 248 XRAY FACIAL BONES, 4 V W/INTERPRETATION XR XR 31 .00 <br /> 201 XRAY RISS,UNILAT.W/PA CHEST & INTERPRET XR XR 31 .00 <br /> 257 XRAY SCOLIOSIS, 1 VIEW XR XR 31 .00 <br /> 236 XRAY ABDOMEN, 3 V W%INTERPRET. XR XR 31 100 <br /> 21i XRAY SPINE, ENTIRE,AP & LAT W/INTERPRET XR XR 31 .00 - <br /> 233 XRAY ABDOMEN, SINGLE AP W/INTERPRET XR XR 31 100 <br />