| Item Number | Description | Schedule Fee |
|---|---|---|
| 45717 | Alveolar cleft (congenital), unilateral, bone grafting of, including local flap closure of associated oro-nasal fistulae and ridge augmentation, other than a service associated with a service to which item 45718 applies (H) (Anaes.) (Assist.) |
$1,371.85 |
| Total: | $1,371.85 | |