Imaging
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Imaging Receipt Example
This receipt documents a chest X-ray at Rush University Medical Imaging with both the technical component ($285.00) and the radiologist interpretation fee ($95.00) billed on a single receipt. Total billed is $380.00. After a $135.60 insurance adjustment, BCBS paid $194.40 of the $244.40 allowed amount, leaving a $50.00 patient responsibility for both imaging components combined.
This imaging receipt documents a chest X-ray (CPT 71045) billed at $250 with $185 insurance adjustment and $65 patient responsibility. The receipt itemizes the radiology service, technical and professional components, and includes the rendering provider NPI for insurance reimbursement.
Receipt Breakdown
What Makes This Receipt Realistic
- • Technical (TC) and professional (26) components shown as separate lines
- • CPT modifier suffixes (-TC, -26) included, required for accurate billing
- • $285.00 technical vs $95.00 professional, realistic 75/25 split for X-ray
- • Single patient responsibility covers both components when on same receipt
- • Math: $380.00 − $135.60 = $244.40 allowed; $244.40 − $194.40 = $50.00 patient
Frequently Asked Questions
What does this imaging receipt show?
This receipt documents a chest X-ray at Rush University Medical Imaging, 1653 W. Congress Pkwy, Chicago, IL 60612. Patient: William T. Osei. Date of Service: May 20, 2025. Ordering Physician: Dr. Lisa Nguyen, MD. Two billed components: CPT 71046-TC: Chest X-Ray, 2 Views, Technical Component (facility and equipment) at $285.00, and CPT 71046-26: Radiologist Interpretation Fee (professional component) at $95.00. Total Billed: $380.00. Insurance Adjustment: −$135.60. Allowed Amount: $244.40. Insurance Paid (BCBS PPO): −$194.40. Patient Responsibility: $50.00. HSA/FSA Eligible.
Why does a chest X-ray show two separate billing lines on the receipt?
Diagnostic imaging generates two separate charges: the technical component (TC) from the imaging facility, which covers the X-ray equipment, X-ray technician, film or digital storage, and facility overhead; and the professional component (modifier 26) from the radiologist who reads and interprets the images. These are billed by two different entities, the hospital or imaging center (TC) and the radiology physician group (26). On this receipt, both appear together on a single document. In other cases, you may receive two separate receipts: one from the imaging center and one from the radiology billing group.
Are chest X-ray and imaging receipts eligible for HSA or FSA reimbursement?
Yes. Diagnostic imaging, X-rays, CT scans, MRIs, and ultrasounds ordered by a physician, are qualified medical expenses under IRS Publication 502 and are fully eligible for HSA and FSA reimbursement. The reimbursable amount is the patient responsibility ($50.00), not the full billed amount. For reimbursement submissions, provide the itemized receipt showing the date of service, imaging center name, CPT code(s), and the amount you paid. If the technical and professional components arrived as two separate bills, submit both receipts; each represents a distinct portion of the total imaging cost.