| Item Number | Description | Schedule Fee |
|---|---|---|
| 30256 | Submandibular gland, extirpation of, other than a service associated with a service to which item 31423, 31426, 31429, 31432, 31435 or 31438 applies on the same side (H) (Anaes.) (Assist.) |
$519.65 |
| Total: | $519.65 | |