| Item Number | Description | Schedule Fee |
|---|---|---|
| 56626 | Computed tomography—scan of knee, with intravenous contrast medium and with any scans of the knee before intravenous contrast injection, when performed, not being a service to which items 56623 or 56630 apply (R) (Anaes.) |
$376.60 |
| Total: | $376.60 | |