Unlisted facial prosthetic procedure

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

PR IMPRSS&PRP INTERIM OBTRTR REPAIR - SIMPLE

Highmark pricing summary

Low

$84

Average

$320

Median

$296

High

$669

Highmark rate distribution

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28 hospital rates

#		Plans
1	ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient	19	$282	$317	$113	36%	—	$145 – $494
2	Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient	3	$378	$375	$115	31%	—	$219 – $524
3	CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · outpatient	19	$272	$308	$105	34%	—	$144 – $469
4	Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges	4	$199	$167	$64	38%	—	$58 – $212
5	Clarion Hospital Clarion, PA facility · fee schedule · outpatient	2	$297	$329	$117	35%	—	$221 – $502
6	Davis Medical Center Elkins, WV facility · case rate · outpatient	1	$225	$225	—	—	—	$225 – $225
7	ERIE COUNTY MEDICAL CENTER CORPORATION Buffalo, NY fee schedule · both	3	$59	$84	$35	42%	—	$59 – $133
8	F.F. Thompson Hospital Canandaigua, NY fee schedule · outpatient	1	$296	$296	—	—	—	$296 – $296
9	GROVE CITY MEDICAL CENTER GROVE CITY, PA fee schedule · outpatient	17	$264	$312	$111	35%	—	$154 – $461
10	Highland Hospital Rochester, NY fee schedule · outpatient	1	$296	$296	—	—	—	$296 – $296
11	Holy Redeemer Health System Meadowbrook, PA facility · case rate · outpatient	1	$253	$253	—	—	—	$253 – $253
12	JEFFERSON REGIONAL MEDICAL CENTER JEFFERSON HILLS, PA fee schedule · outpatient	19	$242	$258	$67	26%	—	$104 – $367
13	Lankenau Medical Center Wynnewood, PA facility · fee schedule · outpatient	1	$272	$272	—	—	—	$272 – $272
14	Memorial Hosp of Wm F & Gertrude F Jones A/K/A Jones Memorial Hosp Wellsville, NY fee schedule · outpatient	3	$508	$488	$132	27%	—	$317 – $639
15	Paoli Hospital Paoli, PA facility · fee schedule · outpatient	1	$270	$270	—	—	—	$270 – $270
16	Riddle Memorial Hospital Media, PA facility · fee schedule · outpatient	1	$270	$270	—	—	—	$270 – $270
17	SAINT VINCENT HEALTH CENTER ERIE, PA fee schedule · outpatient	20	$263	$274	$66	24%	—	$110 – $369
18	ST. CLAIR MEMORIAL HOSPITAL PITTSBURGH, PA fee schedule · both	23	$516	$427	$135	32%	—	$206 – $516
19	St. James Hospital Hornell, NY fee schedule · outpatient	2	$506	$506	$189	37%	—	$317 – $694
20	Strong Memorial Hospital Rochester, NY fee schedule · outpatient	1	$296	$296	—	—	—	$296 – $296
21	TRINITY HOSPITAL HOLDING COMPANY St.Clairsville, OH case rate · outpatient	3	$849	$669	$323	48%	—	$215 – $942
22	The Bryn Mawr Hospital Bryn Mawr, PA facility · fee schedule · outpatient	1	$272	$272	—	—	—	$272 – $272
23	The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA facility · other · outpatient	2	$389	$389	$135	35%	—	$254 – $524
24	WEST PENN ALLEGHENY HEALTH SYSTEM INC WEXFORD, PA fee schedule · outpatient	19	$258	$293	$94	32%	—	$128 – $445
25	WEST PENN ALLEGHENY HEALTH SYSTEM INC PITTSBURGH, PA fee schedule · outpatient	19	$278	$346	$142	41%	—	$159 – $567

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← Payers reporting CPT 21089 · Snapshot 20261111T120946Z-9134e7f7

CPT 21089