go back

Unlisted Face or Jaw Prosthesis Service

North Dakota 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 rates vary

Facilitymedian $1,820 · 10th to 90th $447 to $2,042
$500$1K$2Kfacility $1,820

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
Medica
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
United
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$1,819.70
Typical High
$2,041.74