| Item Number | Description | Schedule Fee |
|---|---|---|
| 56628 | Computed tomography—scan of upper limb, left or right or both, any one region, or more than one region, with intravenous contrast medium and with any scans of the upper limb before intravenous contrast injection, when performed (R) (Anaes.) |
$376.60 |
| Total: | $376.60 | |