| Item Number | Description | Schedule Fee |
|---|---|---|
| 42725 | Vitrectomy via pars plana sclerotomy, including one or more of the following:(a) removal of vitreous; (b) division of vitreous bands; (c) removal of epiretinal membranes; (d) capsulotomy (Anaes.) (Assist.) |
$1,561.40 |
| Total: | $1,561.40 | |