91239 Each additional unit over four
| 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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| 91239 | Each additional unit over four | $124.98 | $124.98 |