| Item Number | Description | Schedule Fee |
|---|---|---|
| 49394 | Revision arthroplasty of hip, including: (a) replacement of proximal femur; and (b) revision of the acetabular component; and (c) bone grafting (if performed) (H) (Anaes.) (Assist.) |
$4,611.90 |
| Total: | $4,611.90 | |