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9 <br />ORANGE FAMILY MEDICAL CENTER c(opy <br />X -RAY SERVICES 060 <br />CHEST CPT CHG PROF <br />Chest, 1 view 71010 31.00 16.00 <br />Chest, apical lordot i c 71021 31.00 16.00 <br />Chest, 2 views 71020 37.00 21.00 <br />Chest, 3 views (stereo, PA, lat.) 71015 50.00 27.00 <br />Chest, 4 views 71030 50.00 27.00 <br />Ribs, unilateral, 3 views 71100 39.00 29.00 <br />Ribs, unilateral, w /PA Chest 71100 &71010 47.00 29.00 <br />Ribs, bilateral, 6 views 71110 52.00 29.00 <br />Ribs, bilateral, w /PA Chest 71110 &71010 62.00 29.00 <br />Sternum, 3 views 71120 36.00 22.00 <br />Sterno- clavicular joints, 3 views 71130 36.00 22.00 <br />SPINE & PELVIS <br />v i ca l Spine, 2 views <br />" V i ca l Spine, 4 -5 views <br />72040 <br />39.00 <br />24.00 <br />"a c i c Spine, 2 views <br />72050 <br />72070 <br />50.00 <br />39.00 <br />)o sa cra l Spine, 2 views <br />72100 <br />35.00 <br />48.00 <br />27.00 <br />27.00 <br />)o sacral Spine, 5 views <br />72110 <br />59.00 <br />34.00 <br />ne, Entire Survey, AP & lateral <br />72010 <br />95.00 <br />61.00 <br />Pelvis, AP <br />Pelvis, stereo, 2 views <br />72170 <br />40.00 <br />22.00 <br />Pelvis & lateral Hip, 2 views <br />72180 <br />73510 <br />47.00 <br />47.00 <br />30.00 <br />Pelvis, 3 views <br />72190 <br />47.00 <br />30.00 <br />35.00 <br />Sa cro-iliac joints, 4 views <br />72202 <br />40.00 <br />24.00 <br />Sacrum & Coccyx <br />72220 <br />41.00 <br />24.00 <br />UPPER EXTREMITIES <br />Clavicle <br />S ou l a, 3 views <br />73000 <br />30.00 <br />22.00 <br />, /der, 2 views <br />73010 <br />73030 <br />40.00 <br />23.00 <br />l de r, 3 views <br />73030 <br />36.00 <br />46.00 <br />20.00 <br />30.00 <br />)mioclavicular joints <br />73050 <br />36.00 <br />22.00 <br />e rus, 2 views <br />E y oo w, 3 views <br />73060 <br />31.00 <br />23.00 <br />Forearm, 2 views <br />73080 <br />73090 <br />35.00 <br />27.00 <br />Wrist, 3 views <br />73110 <br />32.00 <br />36.00 <br />20.00 <br />17.00 <br />Hand, 3 views <br />Finger, 3 views <br />73130 <br />36.00 <br />27.00 <br />Opposing view for comparison <br />73140 <br />76499 <br />31.00 <br />17.00 <br />Post Reduction, 2 views <br />76499 <br />20.00 <br />2-5.00 <br />12.00 <br />17.00 <br />ABDOMEN <br />Abdomen, <br />Abdomen, <br />single AP <br />2 views <br />74000 <br />38.00 <br />24.00 <br />Abdomen, <br />2 views & PA Chest <br />74020 <br />74020 &71010 <br />49.00 <br />55.00 <br />29.00 <br />Abdomen, <br />3 views <br />74010 <br />61.00 <br />36.00 <br />36.00 <br />10/86 <br />