| Item Number | Description | Schedule Fee |
|---|---|---|
| 49388 | Revision arthroplasty of hip, including: (a) revision of both of the following: (i) femoral component with femoral osteotomy; (ii) acetabular component; and (b) minor bone grafting (if performed) (H) (Anaes.) (Assist.) |
$3,228.35 |
| Total: | $3,228.35 | |