CPT 21088
Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Impression and custom preparation; facial prosthesis
Prices here combine facility and professional fees. See them separately →Experimental
Low
$1
Average
$6.3k
Median
$5.5k
High
$55.6k
Showing only prices reported under the case rate methodology. Choose another in the filter below to change the chart. 753 hospitals; the 90th percentile is 4.0× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Click a bar to filter the hospitals table to that price range.
Filter by billing methodology
Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | Lewisgale Hospital Montgomery CHRISTIANSBURG, VA | $4.2k | $6.3k | $6.0k | 96% | — | $2.0k – $20.2k |
| 2 | USA Health University Hospital Mobile, AL | $2.3k | $2.3k | $108 | 5% | — | $2.1k – $2.4k |
| 3 | Fairview Health Services Edina, MN | $4.5k | $4.5k | $1.8k | 40% | — | $1.6k – $7.6k |
| 4 | Aurora Medical Center Mount Pleasant Mount Pleasant, WI | $12.5k | $12.7k | $1.7k | 13% | — | $9.6k – $16.4k |
| 5 | Hca Florida West Hospital PENSACOLA, FL | $15.1k | $18.7k | $13.2k | 71% | — | $1.9k – $40.7k |
| 6 | Mayo Regional Hospital Dover Foxcroft, ME | $16.2k | $16.2k | $1.3k | 8% | — | $14.9k – $17.6k |
| 7 | Deaconess Hospital, Inc Newburgh, IN | $3.2k | $4.8k | $2.2k | 46% | — | $3.0k – $12.2k |
| 8 | Methodist Hospital Hill Country Fredericksburg, TX | $7.8k | $7.0k | $2.9k | 41% | — | $948 – $10.9k |
| 9 | Hca Healthone Northeast Er THORNTON, CO | $6.5k | $6.5k | $3.2k | 49% | — | $1.2k – $11.9k |
| 10 | IHC Health Services Inc., DBA Intermountain Health St George Regional Hospital St. George, UT | $3.4k | $3.4k | $187 | 5% | — | $2.9k – $3.7k |
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