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Our proposed work RVU of 40.00 for CPT code 4X018 is supported by the following reference CPT codes with similar intra-service time (310 minutes) and similar total time (814 minutes): reference CPT code 69970 ( Removal of tumor, temporal bone ) with a work RVU of 32.41 with 330 minutes intra-service time and 793 minutes of total time, and reference CPT code 33864 ( Ascending aorta graft, with cardiopulmonary bypass with valve suspension, with coronary reconstruction and valve-sparing aortic root remodeling (e.g., David Procedure, ( Yacoub Procedure) ) with a work RVU of 60.80 with 300 minutes of intra-service time and 838 minutes of total time