| Item Number | Description | Schedule Fee |
|---|---|---|
| 42788 | Laser capsulotomy—each treatment episode to one eye, to a maximum of 2 treatments to that eye in a 2 year period—other than a service associated with a service to which item 42702 applies (Anaes.) (Assist.) |
$412.25 |
| Total: | $412.25 | |