91234 Four units
| 90000 | GENERAL SERVICES |
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| 91000 | UNCLASSIFIED TREATMENTS |
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| 91200 | UNCLASSIFIED TREATMENT, UNUSUAL TIME AND RESPONSIBILITIES (Note: If the service affected is |
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| 91230 | Management of Exceptional Patient |
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| 91234 | Four units | $499.98 | $499.98 |