Copy of SCHEDULE RFQ Amendment 2.xlsx

XLSX spreadsheet 48 KB Posted Mar 5, 2024

Attached to: Q522--Carroll CBOC X-Ray Services Federal contract opportunity
Solicitation number: 36C26324Q0181
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 23

About this file

Written by GovTribe AI · Mar 5, 2024

This document is a solicitation for radiology x-ray services at the Carroll Community Based Outpatient Clinic in Carroll, Iowa to support the Central Iowa VA Health Care System. The solicitation seeks quotes for a single-award IDIQ contract to provide x-ray services from April 1, 2024 through March 31, 2029. The solicitation includes a list of 104 CPT codes for various x-ray procedures with quantities and units of measure. Quotes are due by February 22, 2024 and are to be emailed to the contracting officer. The solicitation is issued by the Department of Veterans Affairs Veterans Health Administration VISN 23 and has a NAICS code of 622110 with a size standard of $47 million.

View the file

Other files for this federal contract opportunity

Other files attached to Q522--Carroll CBOC X-Ray Services, newest first.
File	Type	Posted
36C26324Q0181 0002_1.docx	DOCX document	Mar 5, 2024
Solicitation Amendment 36C26324Q0181 0002.pdf	PDF	Mar 5, 2024
36C26324Q0181 0001_1.docx	DOCX document	Feb 22, 2024
Solicitation Amendment 36C26324Q0181 0001.pdf	PDF	Feb 22, 2024
P07 Wage Determination.pdf	PDF	Feb 14, 2024
Solicitation 36C26324Q0181.pdf	PDF	Feb 14, 2024
36C26324Q0181_1.docx	DOCX document	Feb 14, 2024
Attachment QASP.pdf	PDF	Feb 14, 2024

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Item Information

Item Number

Description

Contract Period

Pop Begin

Pop End

Quantity

Unit of Measure

Unit Price

Amount

PRINCIPAL NAICS CODE

PRODUCT/SERVICE CODE

UNSPSC

SIC CODE

MANUFACTURER PART NUMBER (MPN)

NATIONAL STOCK NUMBER

LOCAL STOCK NUMBER

0001

CPT Code 74018 Abd 1 View

Base

4/1/24

3/31/25

10.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0002

CPT Code 74019 Abdoment 2V

Base

4/1/24

3/31/25

7.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0003

CPT Code 73610 Ankle 3 view

Base

4/1/24

3/31/25

25.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0004

CPT Code 72050 Cervical 4 views

Base

4/1/24

3/31/25

30.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0005

CPT Code 72052 Cervical 6 view

Base

4/1/24

3/31/25

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0006

CPT code 71046 Chest 2 view

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0007

CPT Code 73000 Clavicle 2 view

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0008

CPT Code 73080 Elbow 3 view

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0009

CPT Code 73070 Elbow 2 view

Base

4/1/24

3/31/25

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0010

CPT Code 70130 Facial Bones 5 view

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0011

CPT Code 73140 Finger(s)

Base

4/1/24

3/31/25

3.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0012

CPT Code 73552 Femur 2 view

Base

4/1/24

3/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0013

CPT Code 73620 Foot 2 view

Base

4/1/24

3/31/25

8.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0014

CPT Code 73630 Foot 3 view

Base

4/1/24

3/31/25

25.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0015

CPT Code 73090 Forearm 2 view

Base

4/1/24

3/31/25

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0016

CPT Code 73130 Hand 3 view

Base

4/1/24

3/31/25

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0017

CPT Code 73523 B/L Hips 5 views

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0018

CPT Code 73521 B/L Hips 2 views

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0019

CPT Code 73502 Hip 2 view

Base

4/1/24

3/31/25

5.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0020

CPT Code 73060 Humerus 2 view

Base

4/1/24

3/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0021

CPT Code 73560 Knee 2 view

Base

4/1/24

3/31/25

10.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0022

CPT Code 73562 Knee 3 view Upright

Base

4/1/24

3/31/25

16.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0023

CPT Code 73564 Knee Complete

Base

4/1/24

3/31/25

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0024

CPT Code 73565 B/L Standing Knee 4 view

Base

4/1/24

3/31/25

8.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0025

CPT Code 73590 Lower Leg 2 view

Base

4/1/24

3/31/25

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0026

CPT Code 72100 Lumbar 3 view

Base

4/1/24

3/31/25

8.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0027

CPT Code 72114 Lumbar 6 views

Base

4/1/24

3/31/25

8.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0028

CPT Code 72110 Lumbar Obliques

Base

4/1/24

3/31/25

25.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0029

CPT Code 73650 Oscalcis 2 view

Base

4/1/24

3/31/25

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0030

CPT Code 72170 Pelvis 1 view

Base

4/1/24

3/31/25

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0031

CPT Code 71111 B/L Ribs w chest

Base

4/1/24

3/31/25

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0032

CPT Code 73510 Uni Ribs

Base

4/1/24

3/31/25

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0033

CPT Code 71101 Ribs w chest

Base

4/1/24

3/31/25

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0034

CPT Code 73010 Scapula

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0035

CPT Code 73030 Shoulder 2 view

Base

4/1/24

3/31/25

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0036

CPT Code 70250 Skull 2 view

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0037

CPT Code 70260 Skull 4 view

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0038

CPT Code 72070 Thoracic 2 view

Base

4/1/24

3/31/25

5.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0039

CPT Code 72072 Thoracic 3 view

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0040

CPT Code 73660 Toe 3 view

Base

4/1/24

3/31/25

3.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0041

CPT Code 73110 Wrist 3 view

Base

4/1/24

3/31/25

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0042

CPT Code 72220 Sacrum/Coccyx

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0043

CPT code 72020 X-ray exam of spine 1 view

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0044

CPT code 72040 X-ray exam neck spine 2-3 vw

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0045

CPT Code 72050 X-ray exam neck spine 4/5vws

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0046

CPT code 72052 X-ray exam neck spine 6/>vws

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0047

CPT code 72070 X-ray exam neck spine 6/>vws

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0048

CPT code 72072 X-ray exam thorac spine 3vws

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0049

CPT code 72074 X-ray exam thorac spine4/>vw

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0050

CPT code 72080 X-ray exam thoracolmb 2/> vw

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0051

CPT code 72081 X-ray exam entire spi 1 vw

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0052

CPT code 72082 X-ray exam entire spi 2/3 vw

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0053

CPT code 72083 X-ray exam entire spi 4/5 vw

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0054

CPT code 72084 X-ray exam entire spi 6/> vw

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0055

CPT code 72100 X-ray exam l-s spine 2/3 vws

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0056

CPT code 72110 X-ray exam l-2 spine 4/>vws

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0057

CPT code 72114 X-ray exam l-s spine bending

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0058

CPT code 72120 X-ray bend only l-s spine

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0059

CPT code 72170 X-ray exam of pelvis

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0060

CPT code 72190 X-ray exam of pelvis

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0061

CPT code 72200 X-ray exam si joints

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0062

CPT code 72202 X-ray exam si joints 3/> vws

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0063

CPT code 72220 X-ray exam sacrum tailbone

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0064

CPT code 72295 X-ray of lower spine disk

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0065

CPT code 73000 X-ray exam of collar bone

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0066

CPT code 73010 X-ray exam of shoulder blade

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0067

CPT code 73020 X-ray exam of shoulder

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0068

CPT code 73030 X-ray exam of shoulder

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0069

CPT code 73050 X-ray exam of shoulders

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0070

CPT code 73060 X-ray exam of humerus

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0071

CPT code 73070 X-ray exam of elbow

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0072

CPT code 73080 X-ray exam of elbow

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0073

CPT code 73090 X-ray exam of forearm

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0074

CPT code 73100 X-ray exam of wrist

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0075

CPT code 73110 X-ray exam of wrist

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0076

CPT code 73120 X-ray exam of hand

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0077

CPT code 73130 X-ray exam of hand

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0078

CPT code 73140 X-ray exam of finger(s)

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0079

CPT code 73501 X-ray exam hip uni 1 view

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0080

CPT code 73502 X-ray exam hip uni 2-3 views

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0081

CPT code 73503 X-ray exam hip uni 4/> views

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0082

CPT code 73521 X-ray exam hips bi 2 views

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0083

CPT code 73522 X-ray exam hips bi 3-4 views

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0084

CPT code 73523 X-ray exam hips bi 5/> views

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0085

CPT code 73551 X-ray exam of femur 1

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0086

CPT code 73552 X-ray exam of femur 2/>

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0087

CPT code 73560 X-ray exam of knee 1 or 2

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0088

CPT code 73562 X-ray exam of knee 3

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0089

CPT code 73564 X-ray exam knee 4 or more

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0090

CPT code 73565 X-ray exam of knees

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0091

CPT code 73590 X-ray exam of lower leg

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0092

CPT code 73600 X-ray exam of ankle

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0093

CPT code 73610 X-ray exam of ankle

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0094

CPT code 73620 X-ray exam of foot

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0095

CPT code 73630 X-ray exam of foot

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0096

CPT code 73650 X-ray exam of heel

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0097

CPT code 73660 X-ray exam of toe(s)

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0098

CPT code 74018 X-ray exam abdomen 1 view

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0099

CPT code 74019 X-ray exam abdomen 2 views

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0100

CPT code 74021 X-ray exam abdomen 3+ views

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0101

CPT code 74022 X-ray exam complete abdomen

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0102

CPT code 77073 X-rays bone length studies

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0103

CPT code 77074 X-rays bone survey limited

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

0104

CPT code 77075 X-rays bone survey complete

Base

4/1/24

3/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1001

CPT Code 74018 Abd 1 View

Option 1

4/1/25

3/31/26

10.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1002

CPT Code 74019 Abdoment 2V

Option 1

4/1/25

3/31/26

7.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1003

CPT Code 73610 Ankle 3 view

Option 1

4/1/25

3/31/26

25.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1004

CPT Code 72050 Cervical 4 views

Option 1

4/1/25

3/31/26

30.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1005

CPT Code 72052 Cervical 6 view

Option 1

4/1/25

3/31/26

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1006

CPT code 71046 Chest 2 view

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1007

CPT Code 73000 Clavicle 2 view

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1008

CPT Code 73080 Elbow 3 view

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1009

CPT Code 73070 Elbow 2 view

Option 1

4/1/25

3/31/26

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1010

CPT Code 70130 Facial Bones 5 view

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1011

CPT Code 73140 Finger(s)

Option 1

4/1/25

3/31/26

3.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1012

CPT Code 73552 Femur 2 view

Option 1

4/1/25

3/31/26

2.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1013

CPT Code 73620 Foot 2 view

Option 1

4/1/25

3/31/26

8.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1014

CPT Code 73630 Foot 3 view

Option 1

4/1/25

3/31/26

25.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1015

CPT Code 73090 Forearm 2 view

Option 1

4/1/25

3/31/26

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1016

CPT Code 73130 Hand 3 view

Option 1

4/1/25

3/31/26

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1017

CPT Code 73523 B/L Hips 5 views

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1018

CPT Code 73521 B/L Hips 2 views

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1019

CPT Code 73502 Hip 2 view

Option 1

4/1/25

3/31/26

5.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1020

CPT Code 73060 Humerus 2 view

Option 1

4/1/25

3/31/26

2.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1021

CPT Code 73560 Knee 2 view

Option 1

4/1/25

3/31/26

10.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1022

CPT Code 73562 Knee 3 view Upright

Option 1

4/1/25

3/31/26

16.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1023

CPT Code 73564 Knee Complete

Option 1

4/1/25

3/31/26

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1024

CPT Code 73565 B/L Standing Knee 4 view

Option 1

4/1/25

3/31/26

8.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1025

CPT Code 73590 Lower Leg 2 view

Option 1

4/1/25

3/31/26

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1026

CPT Code 72100 Lumbar 3 view

Option 1

4/1/25

3/31/26

8.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1027

CPT Code 72114 Lumbar 6 views

Option 1

4/1/25

3/31/26

8.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1028

CPT Code 72110 Lumbar Obliques

Option 1

4/1/25

3/31/26

25.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1029

CPT Code 73650 Oscalcis 2 view

Option 1

4/1/25

3/31/26

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1030

CPT Code 72170 Pelvis 1 view

Option 1

4/1/25

3/31/26

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1031

CPT Code 71111 B/L Ribs w chest

Option 1

4/1/25

3/31/26

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1032

CPT Code 73510 Uni Ribs

Option 1

4/1/25

3/31/26

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1033

CPT Code 71101 Ribs w chest

Option 1

4/1/25

3/31/26

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1034

CPT Code 73010 Scapula

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1035

CPT Code 73030 Shoulder 2 view

Option 1

4/1/25

3/31/26

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1036

CPT Code 70250 Skull 2 view

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1037

CPT Code 70260 Skull 4 view

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1038

CPT Code 72070 Thoracic 2 view

Option 1

4/1/25

3/31/26

5.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1039

CPT Code 72072 Thoracic 3 view

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1040

CPT Code 73660 Toe 3 view

Option 1

4/1/25

3/31/26

3.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1041

CPT Code 73110 Wrist 3 view

Option 1

4/1/25

3/31/26

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1042

CPT Code 72220 Sacrum/Coccyx

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1043

CPT code 72020 X-ray exam of spine 1 view

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1044

CPT code 72040 X-ray exam neck spine 2-3 vw

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1045

CPT Code 72050 X-ray exam neck spine 4/5vws

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1046

CPT code 72052 X-ray exam neck spine 6/>vws

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1047

CPT code 72070 X-ray exam neck spine 6/>vws

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1048

CPT code 72072 X-ray exam thorac spine 3vws

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1049

CPT code 72074 X-ray exam thorac spine4/>vw

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1050

CPT code 72080 X-ray exam thoracolmb 2/> vw

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1051

CPT code 72081 X-ray exam entire spi 1 vw

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1052

CPT code 72082 X-ray exam entire spi 2/3 vw

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1053

CPT code 72083 X-ray exam entire spi 4/5 vw

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1054

CPT code 72084 X-ray exam entire spi 6/> vw

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1055

CPT code 72100 X-ray exam l-s spine 2/3 vws

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1056

CPT code 72110 X-ray exam l-2 spine 4/>vws

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1057

CPT code 72114 X-ray exam l-s spine bending

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1058

CPT code 72120 X-ray bend only l-s spine

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1059

CPT code 72170 X-ray exam of pelvis

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1060

CPT code 72190 X-ray exam of pelvis

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1061

CPT code 72200 X-ray exam si joints

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1062

CPT code 72202 X-ray exam si joints 3/> vws

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1063

CPT code 72220 X-ray exam sacrum tailbone

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1064

CPT code 72295 X-ray of lower spine disk

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1065

CPT code 73000 X-ray exam of collar bone

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1066

CPT code 73010 X-ray exam of shoulder blade

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1067

CPT code 73020 X-ray exam of shoulder

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1068

CPT code 73030 X-ray exam of shoulder

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1069

CPT code 73050 X-ray exam of shoulders

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1070

CPT code 73060 X-ray exam of humerus

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1071

CPT code 73070 X-ray exam of elbow

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1072

CPT code 73080 X-ray exam of elbow

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1073

CPT code 73090 X-ray exam of forearm

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1074

CPT code 73100 X-ray exam of wrist

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1075

CPT code 73110 X-ray exam of wrist

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1076

CPT code 73120 X-ray exam of hand

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1077

CPT code 73130 X-ray exam of hand

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1078

CPT code 73140 X-ray exam of finger(s)

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1079

CPT code 73501 X-ray exam hip uni 1 view

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1080

CPT code 73502 X-ray exam hip uni 2-3 views

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1081

CPT code 73503 X-ray exam hip uni 4/> views

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1082

CPT code 73521 X-ray exam hips bi 2 views

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1083

CPT code 73522 X-ray exam hips bi 3-4 views

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1084

CPT code 73523 X-ray exam hips bi 5/> views

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1085

CPT code 73551 X-ray exam of femur 1

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1086

CPT code 73552 X-ray exam of femur 2/>

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1087

CPT code 73560 X-ray exam of knee 1 or 2

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1088

CPT code 73562 X-ray exam of knee 3

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1089

CPT code 73564 X-ray exam knee 4 or more

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1090

CPT code 73565 X-ray exam of knees

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1091

CPT code 73590 X-ray exam of lower leg

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1092

CPT code 73600 X-ray exam of ankle

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1093

CPT code 73610 X-ray exam of ankle

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1094

CPT code 73620 X-ray exam of foot

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1095

CPT code 73630 X-ray exam of foot

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1096

CPT code 73650 X-ray exam of heel

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1097

CPT code 73660 X-ray exam of toe(s)

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1098

CPT code 74018 X-ray exam abdomen 1 view

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1099

CPT code 74019 X-ray exam abdomen 2 views

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1100

CPT code 74021 X-ray exam abdomen 3+ views

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1101

CPT code 74022 X-ray exam complete abdomen

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1102

CPT code 77073 X-rays bone length studies

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1103

CPT code 77074 X-rays bone survey limited

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

1104

CPT code 77075 X-rays bone survey complete

Option 1

4/1/25

3/31/26

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2001

CPT Code 74018 Abd 1 View

Option 2

4/1/26

3/31/27

10.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2002

CPT Code 74019 Abdoment 2V

Option 2

4/1/26

3/31/27

7.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2003

CPT Code 73610 Ankle 3 view

Option 2

4/1/26

3/31/27

25.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2004

CPT Code 72050 Cervical 4 views

Option 2

4/1/26

3/31/27

30.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2005

CPT Code 72052 Cervical 6 view

Option 2

4/1/26

3/31/27

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2006

CPT code 71046 Chest 2 view

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2007

CPT Code 73000 Clavicle 2 view

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2008

CPT Code 73080 Elbow 3 view

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2009

CPT Code 73070 Elbow 2 view

Option 2

4/1/26

3/31/27

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2010

CPT Code 70130 Facial Bones 5 view

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2011

CPT Code 73140 Finger(s)

Option 2

4/1/26

3/31/27

3.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2012

CPT Code 73552 Femur 2 view

Option 2

4/1/26

3/31/27

2.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2013

CPT Code 73620 Foot 2 view

Option 2

4/1/26

3/31/27

8.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2014

CPT Code 73630 Foot 3 view

Option 2

4/1/26

3/31/27

25.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2015

CPT Code 73090 Forearm 2 view

Option 2

4/1/26

3/31/27

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2016

CPT Code 73130 Hand 3 view

Option 2

4/1/26

3/31/27

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2017

CPT Code 73523 B/L Hips 5 views

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2018

CPT Code 73521 B/L Hips 2 views

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2019

CPT Code 73502 Hip 2 view

Option 2

4/1/26

3/31/27

5.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2020

CPT Code 73060 Humerus 2 view

Option 2

4/1/26

3/31/27

2.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2021

CPT Code 73560 Knee 2 view

Option 2

4/1/26

3/31/27

10.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2022

CPT Code 73562 Knee 3 view Upright

Option 2

4/1/26

3/31/27

16.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2023

CPT Code 73564 Knee Complete

Option 2

4/1/26

3/31/27

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2024

CPT Code 73565 B/L Standing Knee 4 view

Option 2

4/1/26

3/31/27

8.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2025

CPT Code 73590 Lower Leg 2 view

Option 2

4/1/26

3/31/27

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2026

CPT Code 72100 Lumbar 3 view

Option 2

4/1/26

3/31/27

8.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2027

CPT Code 72114 Lumbar 6 views

Option 2

4/1/26

3/31/27

8.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2028

CPT Code 72110 Lumbar Obliques

Option 2

4/1/26

3/31/27

25.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2029

CPT Code 73650 Oscalcis 2 view

Option 2

4/1/26

3/31/27

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2030

CPT Code 72170 Pelvis 1 view

Option 2

4/1/26

3/31/27

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2031

CPT Code 71111 B/L Ribs w chest

Option 2

4/1/26

3/31/27

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2032

CPT Code 73510 Uni Ribs

Option 2

4/1/26

3/31/27

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2033

CPT Code 71101 Ribs w chest

Option 2

4/1/26

3/31/27

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2034

CPT Code 73010 Scapula

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2035

CPT Code 73030 Shoulder 2 view

Option 2

4/1/26

3/31/27

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2036

CPT Code 70250 Skull 2 view

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2037

CPT Code 70260 Skull 4 view

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2038

CPT Code 72070 Thoracic 2 view

Option 2

4/1/26

3/31/27

5.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2039

CPT Code 72072 Thoracic 3 view

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2040

CPT Code 73660 Toe 3 view

Option 2

4/1/26

3/31/27

3.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2041

CPT Code 73110 Wrist 3 view

Option 2

4/1/26

3/31/27

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2042

CPT Code 72220 Sacrum/Coccyx

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2043

CPT code 72020 X-ray exam of spine 1 view

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2044

CPT code 72040 X-ray exam neck spine 2-3 vw

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2045

CPT Code 72050 X-ray exam neck spine 4/5vws

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2046

CPT code 72052 X-ray exam neck spine 6/>vws

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2047

CPT code 72070 X-ray exam neck spine 6/>vws

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2048

CPT code 72072 X-ray exam thorac spine 3vws

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2049

CPT code 72074 X-ray exam thorac spine4/>vw

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2050

CPT code 72080 X-ray exam thoracolmb 2/> vw

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2051

CPT code 72081 X-ray exam entire spi 1 vw

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2052

CPT code 72082 X-ray exam entire spi 2/3 vw

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2053

CPT code 72083 X-ray exam entire spi 4/5 vw

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2054

CPT code 72084 X-ray exam entire spi 6/> vw

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2055

CPT code 72100 X-ray exam l-s spine 2/3 vws

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2056

CPT code 72110 X-ray exam l-2 spine 4/>vws

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2057

CPT code 72114 X-ray exam l-s spine bending

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2058

CPT code 72120 X-ray bend only l-s spine

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2059

CPT code 72170 X-ray exam of pelvis

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2060

CPT code 72190 X-ray exam of pelvis

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2061

CPT code 72200 X-ray exam si joints

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2062

CPT code 72202 X-ray exam si joints 3/> vws

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2063

CPT code 72220 X-ray exam sacrum tailbone

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2064

CPT code 72295 X-ray of lower spine disk

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2065

CPT code 73000 X-ray exam of collar bone

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2066

CPT code 73010 X-ray exam of shoulder blade

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2067

CPT code 73020 X-ray exam of shoulder

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2068

CPT code 73030 X-ray exam of shoulder

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2069

CPT code 73050 X-ray exam of shoulders

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2070

CPT code 73060 X-ray exam of humerus

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2071

CPT code 73070 X-ray exam of elbow

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2072

CPT code 73080 X-ray exam of elbow

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2073

CPT code 73090 X-ray exam of forearm

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2074

CPT code 73100 X-ray exam of wrist

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2075

CPT code 73110 X-ray exam of wrist

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2076

CPT code 73120 X-ray exam of hand

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2077

CPT code 73130 X-ray exam of hand

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2078

CPT code 73140 X-ray exam of finger(s)

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2079

CPT code 73501 X-ray exam hip uni 1 view

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2080

CPT code 73502 X-ray exam hip uni 2-3 views

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2081

CPT code 73503 X-ray exam hip uni 4/> views

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2082

CPT code 73521 X-ray exam hips bi 2 views

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2083

CPT code 73522 X-ray exam hips bi 3-4 views

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2084

CPT code 73523 X-ray exam hips bi 5/> views

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2085

CPT code 73551 X-ray exam of femur 1

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2086

CPT code 73552 X-ray exam of femur 2/>

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2087

CPT code 73560 X-ray exam of knee 1 or 2

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2088

CPT code 73562 X-ray exam of knee 3

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2089

CPT code 73564 X-ray exam knee 4 or more

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2090

CPT code 73565 X-ray exam of knees

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2091

CPT code 73590 X-ray exam of lower leg

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2092

CPT code 73600 X-ray exam of ankle

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2093

CPT code 73610 X-ray exam of ankle

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2094

CPT code 73620 X-ray exam of foot

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2095

CPT code 73630 X-ray exam of foot

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2096

CPT code 73650 X-ray exam of heel

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2097

CPT code 73660 X-ray exam of toe(s)

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2098

CPT code 74018 X-ray exam abdomen 1 view

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2099

CPT code 74019 X-ray exam abdomen 2 views

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2100

CPT code 74021 X-ray exam abdomen 3+ views

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2101

CPT code 74022 X-ray exam complete abdomen

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2102

CPT code 77073 X-rays bone length studies

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2103

CPT code 77074 X-rays bone survey limited

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

2104

CPT code 77075 X-rays bone survey complete

Option 2

4/1/26

3/31/27

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3001

CPT Code 74018 Abd 1 View

Option 3

4/1/27

3/31/28

10.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3002

CPT Code 74019 Abdoment 2V

Option 3

4/1/27

3/31/28

7.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3003

CPT Code 73610 Ankle 3 view

Option 3

4/1/27

3/31/28

25.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3004

CPT Code 72050 Cervical 4 views

Option 3

4/1/27

3/31/28

30.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3005

CPT Code 72052 Cervical 6 view

Option 3

4/1/27

3/31/28

4.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3006

CPT code 71046 Chest 2 view

Option 3

4/1/27

3/31/28

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3007

CPT Code 73000 Clavicle 2 view

Option 3

4/1/27

3/31/28

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3008

CPT Code 73080 Elbow 3 view

Option 3

4/1/27

3/31/28

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3009

CPT Code 73070 Elbow 2 view

Option 3

4/1/27

3/31/28

6.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3010

CPT Code 70130 Facial Bones 5 view

Option 3

4/1/27

3/31/28

1.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3011

CPT Code 73140 Finger(s)

Option 3

4/1/27

3/31/28

3.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3012

CPT Code 73552 Femur 2 view

Option 3

4/1/27

3/31/28

2.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3013

CPT Code 73620 Foot 2 view

Option 3

4/1/27

3/31/28

8.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

3014

CPT Code 73630 Foot 3 view

Option 3

4/1/27

3/31/28

25.00

622110 - General Medical and Surgical Hospitals

Q522 - Medical - Radiology

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Mar 5, 2024.