21085
CPT/HCPCSImpression and custom preparation of oral surgical splint
Physician Fee Schedule
Facility
Medicare Payment
$309.25
Submitted Charge$2,605.20
Medicare Allowed$389.55
Providers72
Beneficiaries154
Total Services161
Office
Medicare Payment
$492.40
Submitted Charge$1,478.48
Medicare Allowed$624.92
Providers257
Beneficiaries2,030
Total Services2,461