| Item Number | Description | Schedule Fee |
|---|---|---|
| 40600 | Cranioplasty, reconstructive, other than a service associated with a service to which item 39113, 39638, 39639, 39641, 39651, 39654, 39656, 39700, 39710, 39712, 39715, 39801, 39803, 40703 or 41887 applies (H) (Anaes.) (Assist.) |
$1,114.10 |
| Total: | $1,114.10 | |