57300 PROSTHESIS, MAXILLOFACIAL, OTHER
| 50000 | PROSTHODONTICS - REMOVABLE |
||
| 57000 | PROSTHESIS, MAXILLOFACIAL |
||
| 57300 | PROSTHESIS, MAXILLOFACIAL, OTHER | ||
| 57301 | Velar Bulb (prosthesis and obturator extra) |
107.2 - 1160.82
+Lab Costs |
107.2 - 1160.82
+Lab Costs |
| 57302 | Velar Lift Button, Mechanical (prosthesis and obturator extra) |
107.2 - 1160.82
+Lab Costs |
107.2 - 1160.82
+Lab Costs |
| 57303 | Retention, Spiral Spring (prosthesis extra) |
696.5
+Lab Costs |
696.5
+Lab Costs |
| 57304 | Retention, Magnetic (prosthesis extra) |
346.69
+Lab Costs |
346.69
+Lab Costs |
| 57305 | Guide Plane, Condylar (prosthesis extra) |
107.21 - 697.58
+Lab Costs |
107.21 - 697.58
+Lab Costs |
| 57306 | Implant, Silastic Chin |
Independent Consideration
+Lab Costs |
Independent Consideration
+Lab Costs |
| 57307 | Mesh Prosthesis, Chrome Cobalt Mandibular Mesh |
Independent Consideration
+Lab Costs |
Independent Consideration
+Lab Costs |
| 57308 | Skull Plate, Customized |
Independent Consideration
+Lab Costs |
Independent Consideration
+Lab Costs |
| 57309 | Akerman, Pseudotemporomandibular Joint (prosthesis extra) |
Independent Consideration
+Lab Costs |
Independent Consideration
+Lab Costs |
| 57311 | Feeding Appliance (for infants with cleft palate) |
536.04 - 1160.82
+Lab Costs |
536.04 - 1160.82
+Lab Costs |
| 57321 | Lingual Prosthesis |
1715.36 - 3485.61
+Lab Costs |
1715.36 - 3485.61
+Lab Costs |
| 57341 | Mandibular Resection Prosthesis with Guide Flange |
1072.1 - 1859.4
+Lab Costs |
1072.1 - 1859.4
+Lab Costs |
| 57342 | Mandibular Resection Prosthesis without Guide Flange |
643.26 - 1392.99
+Lab Costs |
643.26 - 1392.99
+Lab Costs |
| 57351 | Prosthesis, Maxillofacial, Fixed |
Independent Consideration
+Lab Costs |
Independent Consideration
+Lab Costs |
| 57361 | Palatal Augmentation Prosthesis |
750.47 - 1742.81
+Lab Costs |
750.47 - 1742.81
+Lab Costs |
| 57371 | Palatal Life Prosthesis, Modification (relines or repairs) |
214.41 - 813.1
+Lab Costs |
214.41 - 813.1
+Lab Costs |
| 57372 | Gingival Prosthesis |
378.78
+Lab Costs |
378.78
+Lab Costs |