| Item Number | Description | Schedule Fee |
|---|---|---|
| 45540 | Breast reconstruction (bilateral), following mastectomy, using tissue expansion—insertion of tissue expansion unit and all attendances for subsequent expansion injections, other than a service associated with a service to which item 45006 or 45012 applies (H) (Anaes.) (Assist.) |
$2,943.80 |
| Total: | $2,943.80 | |