| Item Number | Description | Schedule Fee |
|---|---|---|
| 40112 | Tethered cord, release of, including lipomeningocele or diastematomyelia, multiple levels, including laminectomy and rhizolysis, other than a service associated with a service to which item 40600 applies (Anaes.) (Assist.) |
$2,787.60 |
| Total: | $2,787.60 | |