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Unlisted Face or Jaw Prosthesis Service

Maryland 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 October 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$209

Typical facility fee. In Maryland, October 2026.

Insurers have agreed to pay about $209 for this service. Most negotiated rates run $107 to $603.

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 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $209 · 10th to 90th $76 to $741Professionalmedian $1,380 · 10th to 90th $1,380 to $1,380
$50$100$200$500$1K$2Kfacility $209professional $1,380

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
CareFirst
Setting
Professional
Modifier
None
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
Cigna
Setting
Facility
Modifier
None
Typical Low
$489.78
Median
$588.84
Typical High
$2,691.53
United
Setting
Facility
Modifier
None
Typical Low
$64.57
Median
$144.54
Typical High
$616.60

Where Maryland sits

The same service costs 38.0 times more in New York than in Montana. 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.

Maryland· 44th of 51

$209

NY $3,020MT $79.43

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.