21089
CPT/HCPCSOther prosthetic procedure for upper jaw and face
Physician Fee Schedule
Facility
Medicare Payment
$457.93
Submitted Charge$2,025.04
Medicare Allowed$574.65
Providers15
Beneficiaries259
Total Services273
Office
Medicare Payment
$395.66
Submitted Charge$990.08
Medicare Allowed$507.09
Providers20
Beneficiaries46
Total Services65