CPT (Current Procedural Terminology) codes are five-digit numbers that describe every medical service or procedure. Your doctor, hospital, and insurance company use them to communicate exactly what was done. Every line on your medical bill has a CPT code, and knowing the code lets you look up what Medicare pays for that same service.

Why do providers charge so much more than Medicare pays?

Providers set their own "chargemaster" prices, which are essentially list prices. Medicare pays a fixed rate based on the resources each service actually requires (the RVU system for procedures, or the Clinical Lab Fee Schedule for lab tests). Commercial insurers typically pay 150% to 250% of Medicare rates. Uninsured patients are often billed the full chargemaster price, which can be 2x to 30x what Medicare pays.

Can I use Medicare rates to negotiate my bill?

Yes. Medicare rates are the closest thing to a "fair price" benchmark in U.S. healthcare. When negotiating, ask the provider what they accept from Medicare for the same CPT code. Most providers will accept 150% to 200% of Medicare for cash-pay patients, which is still far less than their chargemaster price. Many hospital financial assistance policies also use a multiple of Medicare as their discount floor.

How are Medicare rates calculated?

For most procedures, Medicare uses the Resource-Based Relative Value Scale (RBRVS). Each CPT code gets three RVU components: Work (physician time and skill), Practice Expense (overhead), and Malpractice. These are multiplied by geographic adjustment factors (GPCIs) and a conversion factor ($33.4009 in 2026). Lab tests (80000-89999 range) use a separate Clinical Laboratory Fee Schedule with flat national rates.

CPT 73562

X-Ray of Knee, 3 Views

CPT 73562 covers a knee X-ray with 3 views, one of the most commonly ordered imaging studies for arthritis evaluation and injury assessment. Providers charge an average of $118.43, but Medicare pays only $42.42 in an office setting (2.8x markup). Knee X-rays have one of the biggest price gaps between urgent care ($50 to $80) and the ER ($200 to $400), making your choice of facility a major cost factor.

Updated May 2026Source: CMS Physician Fee Schedule

CPT 73562 at a Glance

Average provider charge: $118.43
Medicare physician fee (office): $42.42
Medicare physician fee (hospital): $18.69 + separate facility fee
Typical markup: 2.8x over Medicare office rate

Views: 3 (typically AP, lateral, sunrise/skyline)
Common reasons: Arthritis, injury, post-fall
Related codes: 73560 (1-2 views), 73564 (4+ views)
Medicare beneficiaries (2023): 1.10 million

How the Medicare Rate Is Calculated

Medicare prices every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). Here is the exact math for a 73562 knee X-ray:

Component	What It Covers	Office (Non-Facility)	Hospital (Facility)
Work RVU	Physician time and skill to interpret images	0.17	0.17
Practice Expense RVU	X-ray equipment, technologist, film/digital storage	1.04	0.33
Malpractice RVU	Professional liability insurance	0.04	0.04
Total RVU		1.25	0.54
x $33.4009	2026 conversion factor	$42.42	$18.69

Four different knee X-ray codes exist: There are four CPT codes based on view count: 73560 (1-2 views), 73562 (3 views), 73564 (4+ views, $144 average charge), and 73565 (both knees standing). More views mean higher cost. If you only need a basic injury check, ask your provider whether 2 views are sufficient. However, for arthritis staging, weight-bearing views are often necessary for accurate assessment.

Medicare Rate by State

Medicare adjusts the national rate by location using Geographic Practice Cost Indices (GPCIs). The same knee X-ray pays differently depending on where you live.

Medicare Rate by State (2026)

Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.

Sample State Rates (Office Setting)

State	Medicare Pays	Avg. Charge	Markup
Texas (Austin)	$34.66	$118.43	3.4x
California (Los Angeles)	$36.22	$118.43	3.3x
New York (Manhattan)	$36.22	$118.43	3.3x
Florida (Fort Lauderdale)	$34.96	$118.43	3.4x
Ohio	$32.30	$118.43	3.7x
Mississippi	$31.02	$118.43	3.8x
Arkansas	$30.77	$118.43	3.9x
Alaska	$39.77	$118.43	3.0x

Rates shown are for the non-facility (office) setting using 2026 GPCIs and the $33.4009 conversion factor. The average provider charge of $118.43 is the 2023 national average from CMS utilization data. Actual charges vary by provider.

What Insured Patients Actually Pay for a Knee X-Ray

If you have health insurance, your cost depends on your plan design and where you get the X-ray. Insurers negotiate rates with providers, typically 120% to 200% of the Medicare rate. For a 3-view knee X-ray, the negotiated rate is usually $50 to $85 in an office or urgent care setting.

Your Situation	What You Likely Pay	How It Works
Copay plan (deductible met)	$0 to $30	Many plans cover diagnostic X-rays with a small copay after deductible
Coinsurance plan (deductible met)	$10 to $17	20% of the negotiated rate ($50 to $85)
High-deductible plan (deductible NOT met)	$50 to $118	Full negotiated rate until deductible is met
Medicare Part B	$8.48	20% of the Medicare-approved amount ($42.42)
ER visit (any insurance)	$200 to $400+	X-ray bundled into ER facility fee, significantly higher total

Urgent care vs ER for knee injuries: Unless you suspect an open fracture, cannot move the knee at all, or have severe deformity, a knee X-ray at urgent care is clinically appropriate and costs 3x to 5x less than the ER. Urgent care facilities handle routine knee injuries (suspected sprains, minor fractures, swelling after falls) every day. Save the ER for true emergencies.

Should You Use Insurance or Pay Cash?

For a knee X-ray, many urgent care facilities and imaging centers offer cash prices of $50 to $100 for a 3-view study. If you have a high-deductible plan and have not met your deductible, this cash price may be comparable to or lower than the negotiated rate your insurer would apply.

When Cash-Pay Wins

Urgent care cash price ($50 to $80) is below your insurer's negotiated rate
You have not met your deductible and the entire negotiated rate would apply
You want same-day imaging without a referral or prior authorization
You are uninsured and need to avoid hospital pricing

When Using Insurance Wins

You have met your deductible and the X-ray is covered at copay or coinsurance
You expect follow-up care (MRI, physical therapy, or surgery) and need insurance documentation
Your plan covers diagnostic imaging without applying the deductible
You are close to your out-of-pocket maximum for the year

Think ahead about follow-up costs: A knee X-ray is often just the first step. If the X-ray shows arthritis, you may need an orthopedic consultation ($150 to $300), physical therapy ($50 to $150 per session), or an MRI ($500 to $2,000). If you pay cash for the X-ray, those costs will not count toward your deductible. Consider your likely total knee-related spending for the year before deciding.

Common Billing Problems with Knee X-Rays

Upcoding from 73560 to 73562 or 73564

The most common knee X-ray billing error is coding for more views than were actually taken. 73560 covers 1-2 views, 73562 covers 3 views, and 73564 covers 4+ views. Each step up costs more. Review your radiology report to count the actual views described (AP, lateral, oblique, sunrise, etc.). If 2 views were taken but 73562 was billed, you are being overcharged. Request a correction to 73560.

Billing 73565 (bilateral standing) when only one knee was imaged

CPT 73565 is specifically for bilateral (both knees) standing X-rays used in arthritis comparison. If you only had one knee X-rayed, this code should not appear on your bill. Similarly, if you had a unilateral standing view, it should be coded under 73562 or 73564 depending on view count, not 73565. Check the radiology report to confirm what was actually imaged.

ER facility fee exceeding the X-ray cost by 5x to 10x

In the ER, the knee X-ray itself is a small part of your bill. The ER facility fee ($300 to $1,500), the ER physician evaluation ($100 to $500), and the X-ray ($42 to $118) combine for a total that can exceed $1,000 for what amounts to a basic imaging study. If you went to the ER for a knee injury that turned out to be minor, the facility fee is typically not negotiable, but the ER physician charge may be.

Unnecessary additional views adding cost

Some providers routinely order 4+ view knee X-rays (73564, average $144) when 3 views would be diagnostically sufficient. Weight-bearing views and patellar (sunrise) views are important for specific clinical questions but not always necessary for a simple injury evaluation. If you are being seen for a straightforward knee injury, ask whether the standard 3-view study is adequate before the provider orders additional views that bump the code to 73564.

Related X-Ray Codes

Code	Description	Medicare (Office)	Avg. Charge
73560	Knee X-ray, 1-2 views	$31.36	$85.12
73562	Knee X-ray, 3 views	$42.42	$118.43
73564	Knee X-ray, 4+ views	$51.48	$144.00
73565	Both knees, standing (bilateral)	$34.74	$98.50
73030	Shoulder X-ray, 2+ views	$35.74	$104.94
73502	Hip X-ray, 2-3 views	$48.77	$122.41

Frequently Asked Questions

How much does a knee X-ray cost without insurance?

Without insurance, a 3-view knee X-ray (CPT 73562) costs $50 to $400 depending on the setting. Urgent care clinics typically charge $50 to $100. Freestanding imaging centers charge $60 to $120. Hospital ERs charge $200 to $400 or more due to facility fees. The national average charge is $118.43, and Medicare pays $42.42 in an office setting.

What are the different knee X-ray CPT codes?

There are four knee X-ray codes based on view count: 73560 (1-2 views, $85 average charge), 73562 (3 views, $118 average), 73564 (4+ views, $144 average), and 73565 (both knees standing, used for arthritis comparison). More views provide more diagnostic information but cost more. For a simple injury check, 2 to 3 views are usually sufficient. For arthritis evaluation, weight-bearing views or 4+ views may be clinically necessary.

Is a knee X-ray cheaper at urgent care than the ER?

Yes, significantly. Knee X-rays have one of the largest price gaps between urgent care and ER settings. At urgent care, expect to pay $50 to $100 total for the visit and X-ray combined. At an ER, the same X-ray can cost $200 to $400 or more once the ER facility fee, physician evaluation, and imaging charges are combined. If your knee injury is not a true emergency, urgent care is appropriate and far less expensive.

Do I need weight-bearing knee X-rays for arthritis?

For arthritis evaluation, weight-bearing (standing) views are generally preferred because they show true joint space narrowing under load. Non-weight-bearing X-rays can underestimate arthritis severity by making the joint space appear wider than it actually is when you stand. However, weight-bearing views may require a higher-level code (73564 or 73565), which costs more. Discuss with your doctor whether the additional views will meaningfully change your treatment plan before agreeing to them.

Need Help Lowering a Medical Bill?

CareRoute Bill Defense analyzes the codes on your bill, identifies overcharges and coding errors, and negotiates on your behalf. If your knee X-ray was coded at the wrong view count or your ER bill seems excessive, we can help determine the correct charges and pursue reductions.

Learn about Bill Defense