| Item Number | Description | Schedule Fee |
|---|---|---|
| 56622 | Computed tomography—scan of lower limb, left or right or both, one region (other than knee), or more than one region (which may include knee), without intravenous contrast medium, not being a service to which item 56620 applies (R) (Anaes.) |
$247.55 |
| Total: | $247.55 | |