| Item Number | Description | Schedule Fee |
|---|---|---|
| 45788 | Glenoid fossa, construction of, from bone and cartilage graft, and creation of condyle and ascending ramus of mandible, in hemifacial microsomia, not including harvesting of graft material (H) (Anaes.) (Assist.) |
$1,923.85 |
| Total: | $1,923.85 | |