| Item Number | Description | Schedule Fee |
|---|---|---|
| 49396 | Revision arthroplasty of hip, including: (a) removal of prosthesis as stage 1 of a 2-stage revision arthroplasty or as a definitive stage procedure; and (b) insertion of temporary prosthesis (if performed) (H) (Anaes.) (Assist.) |
$3,074.60 |
| Total: | $3,074.60 | |