| Item Number | Description | Schedule Fee |
|---|---|---|
| 46154 | Maxilla, procedure for reshaping arch of, by complex segmental osteotomies, including fixation by any means (including application of distractors if used), one service per patient on the same occasion (H) (Anaes.) (Assist.) |
$1,770.45 |
| Total: | $1,770.45 | |