57100 PROSTHESIS, FACIAL
| 50000 | PROSTHODONTICS - REMOVABLE |
||
| 57000 | PROSTHESIS, MAXILLOFACIAL |
||
| 57100 | PROSTHESIS, FACIAL | ||
| 57101 | Orbital |
2465.85 - 5809.38
+Lab Costs |
2465.85 - 5809.38
+Lab Costs |
| 57102 | Nose |
1929.79 - 3949.96
+Lab Costs |
1929.79 - 3949.96
+Lab Costs |
| 57103 | Ear |
1929.79 - 3949.96
+Lab Costs |
1929.79 - 3949.96
+Lab Costs |
| 57104 | Patch |
579.88
+Lab Costs |
579.88
+Lab Costs |
| 57105 | Facial, Complex |
2465.85 - 4763.06
+Lab Costs |
2465.85 - 4763.06
+Lab Costs |
| 57106 | Facial Moulage Impression, Complete |
378.78 | 378.78 |
| 57107 | Facial Moulage Impression, Sectional |
284.08 | 284.08 |
| 57108 | Ocular Conformer Prosthesis (temporary post-surgical) |
579.88
+Lab Costs |
579.88
+Lab Costs |
| 57109 | Ocular Prosthesis |
750.47 - 3135.8
+Lab Costs |
750.47 - 3135.8
+Lab Costs |