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Custom-Made Facial Prosthesis

Montana rates for HCPCS 21088

Taking an impression of the face and custom-building an artificial replacement for a part of the face that has been lost through injury, cancer surgery, or a difference present from birth. The prosthesis is sculpted and colored to match the surrounding skin so it blends in, then fitted and adjusted until it sits correctly.

Rates data updated July 2026.

How much does Custom-Made Facial Prosthesis cost?

$4,365

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $4,365 for this service. The price depends on where it is billed: about $4,365 from a physician practice, and about $5,888 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$4,365$3,020 to $5,370
FacilityA hospital or hospital-owned outpatient department$5,888$5,248 to $5,888

How much rates vary

Facilitymedian $5,888 · 10th to 90th $4,365 to $6,761Professionalmedian $4,365 · 10th to 90th $955 to $5,888
$100$200$500$1K$2K$5K$10Kfacility $5,888professional $4,365

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$3,311.31
Typical High
$4,365.16
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5,370.32
Median
$5,370.32
Typical High
$5,370.32
Cigna
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$5,370.32
Typical High
$9,332.54
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$4,365.16
Median
$5,888.44
Typical High
$6,165.95
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$4,365.16
Median
$5,888.44
Typical High
$6,165.95
Providence
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$4,265.80
Typical High
$7,244.36
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$2,398.83
Typical High
$6,165.95
United
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$6,760.83
United
Setting
Professional
Modifier
Global
Typical Low
$2,754.23
Median
$4,897.79
Typical High
$6,025.60

Where Montana sits

The same service costs 19.5 times more in New Hampshire than in Minnesota. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Montana· 8th of 51

$4,365

NH $5,888MN $302

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.