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15
<br /> ORANGE FAMILY MEDICAL GROUP PA
<br /> 06/15/93 PROCEDURE FEES PAGE 6
<br /> PROCEDURE DESCRIPTION ALT, DESC. DEPT T.O.S. STD, FEE
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<br /> /1030 XRAY,CHEST, 3 VIEWS,W/INTREPRET. XR XR 0 96.00
<br /> 25: XRAY SELLA TURCICA, 2 V W/INTERPRET XR XR 31 .00
<br /> 91 XRAY,CHESi,2 VIEWS, W/INTERPRET. XR XR 31 .00
<br /> 226 XRAY FOREARM, 2 VIEWS wiINTERPRET %R XR 31 .00
<br /> 223 XRAY ACROMIOCLAV.JOINTS 0/INTERPRET XR XR 31 .00
<br /> 258 XRAY FEMUR W/INTERPRET XR XR 31 .00
<br /> 239 XRAY TIBIA&FIBULA W/INTERPRETATION KR XR 31 ,00
<br /> 220 XRAY SCAPULA, 3 V W/INTERPRETATION XR XR 31 .00
<br /> 205 XRAY ST ERNO-CLAV.JOINTS,3VIEWS W/INTERPR XR XR 31 .00
<br /> 206 XRAY CERVICAL SPINE, 2 VIEWS W/INTERPRET XR XR 31 ,00
<br /> 72110 XRAY,L/S SPINE,5 VIEWS W/INTERPRET. XR XR 0 128.00
<br /> 198 XRAY,CHEST,3VIEWS,W/INTERPRET. XR XR 31 .00
<br /> 203 XRAY RIBS,BILAT,W/CHEST PA & INTERPRET XR XR 31 .00
<br /> 229 XRAY FINGER, 3 V W/INTERPRET XR XR 31 .00
<br /> 245 XRAY SKULL 6 VIEWS W/INTERPRET XR XR 31 .00
<br /> 200 XRAY RIBS,UNILATERAL,3VIEWS W/INTERPRETY XR XR 3i ,00
<br /> 72100 XRAY, L/S SPINE, 2 VIEWS W/INTERPRET. XR XR 0 96.00
<br /> 255 TEM.MANDIBULAR JOINT,BILAT.6 V W/INTER. XR XR 3i .00
<br /> 246 XRAY SKULL, 4 VIEWS W/INTERPRET XR XR 31 .00
<br /> 243 XRAY FOOT 2 VIEWS W/INTERPRET XR XR 31 .00
<br /> 256 XRAY NECK SOFT TISSUE 2 V W/INTERPRET XR XR 31 .00
<br /> 11120 XRAY,STERUM, 3 VIEWS W/INTERPRET, XR XR 31 .00
<br /> 71021 CHEST APICAL l:,RDOTIC X-RAY XR 1 47.00
<br /> '53 XRAY ZYGOMATIC ARCHES,6V W/'FACIAL&INTERP XR XR 31 .00
<br /> '1010 XRAY,CHEST, 1 VIEW W/INTREPRET, XR XR 0 61.00
<br /> 215 PELVIS, 3 VIEWS, W/INTERPRETATION XR XR 31 ,00
<br /> 224 XRAY HUMERUS, 2 VIEWS W/INTERPRET XR XR 31 ,00
<br /> 240 XRAY ANKLE 2 VIEWS W/INTERPRET. XR XR 31 .00
<br /> 250 XRAY SELLA TURCICA, i VIEW W/INTERPRET XR XR 31 .00
<br /> 209 XRAY, L/S SPINE 2 VIEWS W/INTERPRET XR XR 0 .00
<br /> :96 XRAY,CHEST,APTCAL LORDOTIC W/INTERPRET. XR XR 31 ,00
<br /> '2010 XRAY, THORASIC SPINE,2 VIEWS W/INTERPRET XR XR 0 77.00
<br /> .10 XRAY SACROILIAC JOINTS,4 V,W/INTERPRET XR XR 31 .00
<br /> 227 %RAY WRIST, 3 V W/INTERPRET XR XR 31 .00
<br /> 234 X?AY ABDOMEN, 2 V '+!/INTERPRET XR XR 31 .00
<br /> 213 XRAY PELVIS, STEREO,2 V W/INTERPRET XR XR 31 .00
<br /> :95 XRAY,CHEST,IVIEW W/ INTERPRETATION XR XR 31 .00
<br /> '31 XRAY KNEE, 2 VIEWS W/INTERPRETATION XR XR 31 .00
<br /> 249 XRAY .NASAL BONES 4 V W/INTERPRET XR XR 31 ,00
<br /> '22 XRAY, SHOULDER, 3 V, W/INTERPRET XR XR 31 .00
<br /> 2:0 L/S SPINE ,5 VIEWS W/INTERPRETATION XR XR 31 .00
<br /> 259 XRAY TOES, W/INTERPRETATION XR XR 31 ,00
<br /> 221 ;TRAY SHOULDER, 2 V, W/INTERPRETATION XR XR 31 .00
<br /> 232 XRAY NAVICULAR W/INTEPRET XR XR 31 .00
<br /> 1:130 XRAY STERNO-CLAV.JOINTS,3VIEWS W/INTER, XR XR 0 71.00
<br /> 231 XRAY POST REDUCTION,2 V W/INTERPRET XR XR 31 .00
<br /> 199 CHEST, 4 VIEWS W/INTERPRETATION XR XR 31 .00
<br /> 219 XRAY CLAVICLE, 2 V W/INTERPRETATION XR XR 31 .00
<br /> 228 XRAY HAND, 3 VIEWS W/INTERPET XR XR 31 .00
<br /> 244 XRAY OS CALCIS, 2 VIEWS W/INTERPRET XR XR 31 ,00
<br /> 238 XRAY KNEE 3 VIEWS W/INTERPRETATION XR XR 31 ,00
<br /> 247 XRAY SINUSES, 4 VIEWS W/INTERPRET XR XR 31 .00
<br /> 72050 XRAY, CERVICAL SPINE,4-5 V W/INTERPRET. XR XR 0 116.00
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