14811 Maxillary Appliance

10000	PREVENTION
14000	APPLIANCES
14800	APPLIANCES, MYOFACIAL PAIN DYSFUNCTION SYNDROME
14810	Appliance, Myofascial Pain Dysfunction Syndrome, (to include: models, gnathological determinants) Appliance Construction only, and insertion adjustment (no post-insertion adjustments)
14811	Maxillary Appliance	$725.96 +Lab Costs	$725.96 +Lab Costs