| Item Number | Description | Schedule Fee |
|---|---|---|
| 56623 | 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), with intravenous contrast medium and with any scans of the lower limb before intravenous contrast injection, when performed, not being a service to which item 56626 applies (R) (Anaes.) |
$376.60 |
| Total: | $376.60 | |