| Item Number | Description | Schedule Fee |
|---|---|---|
| 36543 | Nephrolithotomy or pyelolithotomy, or both, extended, for one or more renal stones, including one or more of nephrostomy, pyelostomy, pedicle control with or without freezing, calyorrhaphy or pyeloplasty (H) (Anaes.) (Assist.) |
$1,506.20 |
| Total: | $1,506.20 | |