| Item Number | Description | Schedule Fee |
|---|---|---|
| 45590 | Orbital cavity, reconstruction of wall or floor, with or without bone graft, cartilage graft or foreign implant, other than a service associated with a service to which item 42530 or 45594 applies on the same side (H) (Anaes.) (Assist.) |
$563.75 |
| Total: | $563.75 | |