| Item Number | Description | Schedule Fee |
|---|---|---|
| 56401 | Computed tomography—scan of upper abdomen only (diaphragm to iliac crest) without intravenous contrast medium, not being a service to which item 56301, 56501, 56801 or 57001 applies (R) (Anaes.) |
$281.35 |
| Total: | $281.35 | |