Chiropractic Fee Schedule

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#FFFFFF" TEXT="#080000" background="3aafd5a3.jpg"> <div> <B>Benefit</B><FONT SIZE="5" COLOR="#FF0000" FACE="Optimum-Roman-DTC" ><B>Source</B></FONT><FONT SIZE="4" COLOR="#FF0000" FACE="Arial" ><B> <small><sup>©</sup></small>     </B></FONT></div> <div> <A HREF="index.htm" TARGET="_top" TITLE=" BenefitSource "><B><U>H</U></B></A><A HREF="index.htm" TARGET="_top" TITLE=" BenefitSource "><B><U>ome</U></B></A><B><U>     |     </U></B><B><U>Chiropractic Fee Schedule</U></B></div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFFFFF" TEXT="#080000"> <bR> <bR> <div> <IMG SRC="32c366a0.png" border=0 width="54" height="106" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>Good</B></div> <div> <B>Health</B></div> <bR> </td> <td valign="top" height=390 width="100%" BGCOLOR="#FFFFFF" TEXT="#080000"> <bR> <div> <B> <A NAME="chiropractic_fee_schedule"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Chiropractic Fee Schedule</B></div> <div> <B><IMG SRC="38a62620.gif" border=0 width="98" height="98" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="669" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 26 WIDTH="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="26" ALIGN="bottom" WIDTH="82" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="480"><div> <B>BenefitSource</B></div> </tD> <tD VALIGN=TOP WIDTH="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="26" ALIGN="bottom" WIDTH="97" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 26 WIDTH="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="26" ALIGN="bottom" WIDTH="82" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="480"><div> <B>Chiropractic Fee Schedule</B></div> </tD> <tD VALIGN=TOP WIDTH="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="26" ALIGN="bottom" WIDTH="97" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="82" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="480"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="480" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="97" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 ><NOBR><div> CPT Code</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="480"><div> Description</div> </tD> <tD VALIGN=TOP><NOBR><div> Fee Schedule</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="82" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="480"><div> <B>Evaluation and Management</B></div> </tD> <tD VALIGN=TOP WIDTH="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="97" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="82" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="480"><div> <B>New Patient</B></div> </tD> <tD VALIGN=TOP WIDTH="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="97" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 99201</div> </tD> <tD VALIGN=TOP><NOBR><div> Problem focused history and examination-straightforward</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> $11.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 99202</div> </tD> <tD VALIGN=TOP><NOBR><div> Expanded history and examination-straightforward</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> $13.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 99203</div> </tD> <tD VALIGN=TOP><NOBR><div> Detailed history and examination- low complexity</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> $17.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 99204</div> </tD> <tD VALIGN=TOP><NOBR><div> Comprehensive history and examination- moderate complexity</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> $17.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="82" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="480"><div> <B>Established Patient</B></div> </tD> <tD VALIGN=TOP WIDTH="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="97" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 99211</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Minimal Service</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> N/C</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 99212</div> </tD> <tD VALIGN=TOP><NOBR><div> Problem focused history and examination-straightforward</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> N/C</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 99213</div> </tD> <tD VALIGN=TOP><NOBR><div> Expanded history and examination- low complexity</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> N/C</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 99214</div> </tD> <tD VALIGN=TOP><NOBR><div> Detailed history and examination- moderate complexity</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> N/C</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="82" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="480"><div> <B>Chiropractic Manipulative Therapy</B></div> </tD> <tD VALIGN=TOP WIDTH="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="97" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 98940</div> </tD> <tD VALIGN=TOP><NOBR><div> Chiropractic manipulative treatment: spinal, one to two regions</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> $34.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 98941</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Spinal Three to Four Regions</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $36.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 98942</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Spinal, Five Regions</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $38.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 98943</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Extraspinal, One or More Regions</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $26.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="82" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP><NOBR><div> <B>Modalities- </B>The application of the following modalities do not require </div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="97" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="82" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="480"><div> one-on-one patient contact by the provider</div> </tD> <tD VALIGN=TOP WIDTH="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="97" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97010</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Application of hot/cold packs</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> N/C</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97012</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Traction, Mechanical</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $16.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97014</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Electrical Stimulation (unattended)</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $16.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97016</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Vasopneumatic Devices</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $16.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97018</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Paraffin Bath</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $21.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97020</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Microwave</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $17.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97022</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Whirlpool</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $18.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97024</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Diathermy</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $16.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97026</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Infrared</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $16.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97028</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Ultraviolet</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $18.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="82" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="480"><div> <B>Supportive Procedures</B></div> </tD> <tD VALIGN=TOP WIDTH="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="97" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="82" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP><NOBR><div> <B>The Application of the Following Modalities Require</B></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="97" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="82" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP><NOBR><div> <B>Direct One-On-One Patient Contact by the Provider</B></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="97" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97032</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Electrical Stimulation- manual</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $16.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97033</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Iontophoresis</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $21.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97034</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Contrast Baths</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $16.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97035</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Ultrasound</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $21.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97036</div> </tD> <tD VALIGN=TOP><NOBR><div> Hubbard Tank; Each Additional 15 Min. up to One Hour</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> $21.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97110</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Therapeutic Exercise, 15 Min.</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $18.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97112</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Neuromuscular Reeducation</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $18.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97116</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Gait Training</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $18.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97122</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Traction, Manual</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $18.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 97124</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Massage</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $18.00</div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="669" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="82" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="480"><div> <B>Radiographic Studies- X-Rays</B></div> </tD> <tD VALIGN=TOP WIDTH="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="97" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 72040</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Cervical 3 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $34.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 72070</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Dorsal 2 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $34.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 72100</div> </tD> <tD VALIGN=TOP><NOBR><div> Spine, Lumbosacral Anteroposterior and Lateral</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> $34.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 72110</div> </tD> <tD VALIGN=TOP><NOBR><div> Spine, Lumbosacral, Complete with Oblique Views</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> $46.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 72114</div> </tD> <tD VALIGN=TOP><NOBR><div> Spine, Lumbosacral, Complete Including Bending Views</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> $56.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 72120</div> </tD> <tD VALIGN=TOP><NOBR><div> Spine, Lumbosacral, Bending Views Only, Min. of 4 Views</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> $39.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 72170</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Pelvis, AP Only</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $31.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 72190</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Pelvis, Complete Min. of 3 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $37.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 72200</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Sacroiliac Joints Less Than 3 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $31.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 72202</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Sacroiliac Joints 3 or More Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $33.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 72220</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Sacrum and Coccyx Min. of 2 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $31.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73000</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Clavicle, Complete</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $24.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73010</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Scapula, Complete</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $27.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73020</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Shoulder, 1 View</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $23.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73030</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Shoulder, Complete Min. of 2 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $27.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73050</div> </tD> <tD VALIGN=TOP><NOBR><div> Arcomioclavicular Joints Bilater, W/Wout Weighted Distraction</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> $31.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73060</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Humerus Min. of 2 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $29.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73070</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Elbow, AP and Lateral Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $26.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73080</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Elbow, Complete Minimum of 3 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $27.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73090</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Forearm</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $25.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73092</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Upper Extremity, Infant Min of 2 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $25.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73100</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Wrist, AP and Lateral Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $25.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73110</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Wrist, Complete Min. of 3 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $27.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73120</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Hand, 2 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $23.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73130</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Hand, Minimum of 3 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $29.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73500</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Hip Unilateral, 1 View</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $25.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73510</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Hip, Complete Min. of 2 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $31.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 38 WIDTH="82"><div> 73520</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Hips, Bilateral, Minimum of 2 Views of Each Hip, Including AP View of Pelvis</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $36.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73540</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Pelvis and Hips, Infant Child, Min. of 2 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $30.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73550</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Femur, AP and Lateral Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $29.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73560</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Knee, AP and Lateral Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $25.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73562</div> </tD> <tD VALIGN=TOP><NOBR><div> Knee, AP and Lateral With Oblique(s), Min. of 3 Views</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="97"><div> $29.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 38 WIDTH="82"><div> 73564</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Knee Complete Incl. Oblique(s) and Tunnel, and/or Patellar and/or Standing Vw.</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $31.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73565</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Both Knees Standing, AP</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $46.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73590</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Tibia and Fibula AP and Lateral Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $25.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73592</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Lower Extremity, Infant Min. of 2 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $24.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73600</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Ankle, AP and Lateral Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $24.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73610</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Ankle, Complete Min. of 3 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $29.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73620</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Foot, AP and Lateral Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $24.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73630</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Foot, Complete Min. of 3 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $27.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73650</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Calcaneus Min. of 2 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $24.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 73660</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Toe(s) Min. of 2 Views</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $21.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="82"><div> 74000</div> </tD> <tD VALIGN=TOP WIDTH="480"><div> Abdomen Single AP View</div> </tD> <tD VALIGN=TOP WIDTH="97"><div> $26.00</div> </tD> </tR> </TABLE></div> <bR> <div> <A HREF="#chiropractic_fee_schedule" TITLE="Chiropractic Fee Schedule"><B><U>Top of Page</U></B></A></div> <bR> </td> </tr></table></body>