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
Provisional pontic
Low
$1
Average
$563
Median
$387
High
$1.8k
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Prices here combine facility and professional fees. See them separately →Experimental
Reflects negotiated fee schedule rates with commercial payers.
Showing only prices reported under the fee schedule methodology. Choose another in the filter above to change the chart. 184 hospitals; the 90th percentile is 8.4× 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.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | St. Anthony Shawnee Hospital, Inc Shawnee, OK | $369 | $369 | — | — | — | $369 – $369 |
| 2 | Mayo Regional Hospital Dover Foxcroft, ME | $220 | $283 | $102 | 36% | — | $202 – $474 |
| 3 | Baptist Medical Center of the Beaches, INC Beach, FL | $73 | $73 | — | — | — | $73 – $73 |
| 4 | Westfield Memorial Hospital Inc WESTFIELD, NY | $170 | $212 | $70 | 33% | — | $170 – $369 |
| 5 | Gundersen Luthern Medical Center Inc La Crosse, WI | $46 | $205 | $246 | 120% | — | $46 – $675 |
| 6 | Spohn Hospital Beeville Beeville, TX | $335 | $335 | — | — | — | $335 – $335 |
| 7 | Spohn Hospital Alice Alice, TX | $335 | $335 | — | — | — | $335 – $335 |
| 8 | OSF Saint Francis Medical Center Peoria, IL | $187 | $187 | — | — | — | $187 – $187 |
| 9 | Covenant Medical Center Lubbock, TX | $894 | $894 | — | — | — | $894 – $894 |
| 10 | Corewell Health Butterworth Hospital Grand Rapids, MI | $184 | $183 | $38 | 21% | — | $132 – $232 |
Ask Claude or any MCP client for HCPCS D6253 pricing at a specific hospital — see how to connect.