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Unlisted Face or Jaw Prosthesis Service

Massachusetts rates for HCPCS 21089

Covers the making or fitting of an artificial replacement for a missing or damaged part of the face, jaw or mouth when no standard named service applies. These custom devices restore appearance and function after cancer surgery, injury, or a condition present from birth. Because each one is built for a single person, the specialist records exactly what was designed and fitted.

Rates data updated July 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$1,122

Typical facility fee. In Massachusetts, July 2026.

Insurers have agreed to pay about $1,122 for this service. Most negotiated rates run $457 to $2,692.

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.

How much rates vary

Facilitymedian $1,122 · 10th to 90th $56 to $3,631Professionalmedian $54 · 10th to 90th $49 to $63
$0.1$1$10$100$1K$10Kfacility $1,122professional $54

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$0.03
Median
$630.96
Typical High
$2,818.38
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,311.31
Typical High
$8,511.38
Harvard Pilgrim
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$2,041.74
Typical High
$3,467.37
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$0.03
Median
$630.96
Typical High
$2,818.38
United
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$1,819.70
Typical High
$2,754.23
United
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$53.70
Typical High
$63.10

Where Massachusetts sits

The same service costs 1148.2 times more in Pennsylvania than in Maryland. 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.

Massachusetts· 20th of 49

$1,122

PA $54,954MD $47.86

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.