04730 Split Cast Mounting, Diagnostic

00000

DIAGNOSTIC

04000

TEST/ANALYSIS/LABORATORY PROCEDURES/INTERPRETATION AND/OR REPORTS

04700

SUPPLEMENTARY DIAGNOSTIC PROCEDURES (INTERPRETATION ONLY)

04730 Split Cast Mounting, Diagnostic
04731

One unit of time

77.9
+Lab Costs
77.9
+Lab Costs
04732

Two units

155.8
+Lab Costs
155.8
+Lab Costs
04733

Three units

233.72
+Lab Costs
233.72
+Lab Costs
04734

Four units

311.62
+Lab Costs
311.62
+Lab Costs
04739

Each additional unit over four

77.9
+Lab Costs
77.9
+Lab Costs
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