| Item Number | Description | Schedule Fee |
|---|---|---|
| 58120 | Spine—4 regions, cervical, thoracic, lumbosacral and sacrococcygeal, if the service to which item 58120 or 58121 applies has not been performed on the same patient within the same calendar year (R) |
$126.25 |
| Total: | $126.25 | |