go back

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.

Facilitymedian $1,122 · 10th–90th $56$3,6310%10%10th90th$1,122Professionalmedian $54 · 10th–90th $49$630%20%10th90th$54$0.1$0.5$5.0$50.0$500.0$5.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

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