04911 Cast, Diagnostic, Unmounted
| 00000 | DIAGNOSTIC |
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| 04000 | TEST/ANALYSIS/LABORATORY PROCEDURES/INTERPRETATION AND/OR REPORTS |
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| 04900 | CASTS, DIAGNOSTIC (technical procedure only) |
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| 04910 | Cast, Diagnostic, Unmounted |
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| 04911 | Cast, Diagnostic, Unmounted |
$83.39
+Lab Costs |
$83.39
+Lab Costs |