04913 Casts, Diagnositc, Unmounted, Upper and Lower Combined
| 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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| 04913 | Casts, Diagnositc, Unmounted, Upper and Lower Combined |
$175.16
+Lab Costs |
$175.16
+Lab Costs |