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Unlisted Face or Jaw Prosthesis Service

New Jersey 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 $2,630 · 10th to 90th $741 to $6,607
$500$1K$2K$5K$10Kfacility $2,630

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
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$741.31
Typical High
$1,174.90
United
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$2,754.23
Typical High
$6,760.83