|
CPT
|
Fee
|
TOS
|
Radiology
|
|
72040
|
$
95
|
$
71
|
Spine,
cervical; two or three views
|
|
72050
|
$197
|
$
148
|
Spine,
cervical; minimum of four views
|
|
72052
|
$169
|
$
126
|
Spine,
cervical; complete, including oblique and flexion and/or extension
|
|
72070
|
$105
|
$
79
|
Spine,
thoracic; two views
|
|
72080
|
$115
|
$
86
|
Spine,
thoracolumbar; two views
|
|
72100
|
$116
|
$
87
|
Spine,
lumbosacral; two or three views
|
|
72110
|
$219
|
$
164
|
Spine,
lumbosacral; minimum of four views
|
|
72114
|
$257
|
$
193
|
Spine,
lumbosacral; complete, including bending views
|
|
72120
|
$153
|
$
115
|
Spine,
lumbosacral, bending views only, minimum of 4 views
|
|
72170
|
$
97
|
$
73
|
Pelvis;
one or two views
|
|
73030
|
$110
|
$
82
|
Shoulder;
complete, minimum of two views
|
|
73070
|
$
72
|
$
54
|
Elbow;
two views
|
|
73080
|
$103
|
$
78
|
Elbow;
complete, minimum of three view
|
|
73100
|
$
73
|
$
55
|
Wrist;
two views
|
|
73110
|
$103
|
$
77
|
Wrist;
complete, minimum of three views
|
|
73120
|
$
70
|
$
53
|
Hand;
two views
|
|
73130
|
$103
|
$
77
|
Hand:
minimum of three views
|
|
73510
|
$120
|
$
90
|
Hip,
unilateral, complete, minimum of two views
|
|
73520
|
$167
|
$
125
|
Hips,
bilateral, minimum of two view of each hip, including AP view of
pelvis
|
|
73560
|
$
79
|
$
59
|
Knee;
one or two views
|
|
73562
|
$104
|
$
78
|
Knee;
three views
|
|
73564
|
$
86
|
$
65
|
Knee;
complete, four or more views
|
|
73600
|
$
66
|
$
50
|
Ankle;
2 views
|
|
73610
|
$110
|
$
82
|
Ankle;
complete, minimum of three views
|
|
73620
|
$
66
|
$
50
|
Foot;
two views
|
|
73630
|
$104
|
$
78
|
Foot;
complete, minimum of
three views
|
