| Item Number | Description | Schedule Fee |
|---|---|---|
| 38839 | Pericardium, subxiphoid open surgical drainage of, other than a service associated with a service to which item 18258, 18260, 38815, 38816, 38828 or 38840 applies (H) (Anaes.) (Assist.) |
$669.30 |
| Total: | $669.30 | |