| Item Number | Description | Schedule Fee |
|---|---|---|
| 49554 | Revision of total replacement of knee, by anatomic specific allograft of tibia or femur, other than a service to which item 48245, 48248, 48251, 48254 or 48257 applies (H) (Anaes.) (Assist.) |
$2,196.65 |
| Total: | $2,196.65 | |