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Unlisted Face or Jaw Prosthesis Service

New York 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?

$3,020

Typical negotiated rate. In New York, October 2026.

Insurers have agreed to pay about $3,020 for this service. The price depends on where it is billed: about $398 from a physician practice, and about $3,090 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$398$398 to $398
FacilityA hospital or hospital-owned outpatient department$3,090$1,413 to $4,786

How much rates vary

Facilitymedian $3,090 · 10th to 90th $603 to $6,918Professionalmedian $398 · 10th to 90th $65 to $708
$100$200$500$1K$2K$5K$10Kfacility $3,090professional $398

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
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$1,288.25
Median
$3,890.45
Typical High
$7,943.28
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$50.12
Median
$50.12
Typical High
$50.12
Cigna
Setting
Facility
Modifier
None
Typical Low
$851.14
Median
$1,778.28
Typical High
$2,754.23
Emblem Health
Setting
Facility
Modifier
None
Typical Low
$3,548.13
Median
$3,548.13
Typical High
$3,548.13
MVP Health Care
Setting
Professional
Modifier
None
Typical Low
$398.11
Median
$398.11
Typical High
$707.95
United
Setting
Facility
Modifier
None
Typical Low
$363.08
Median
$1,148.15
Typical High
$4,365.16
United
Setting
Professional
Modifier
None
Typical Low
$64.57
Median
$64.57
Typical High
$977.24

Where New York 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.

New York· 1st of 51

$3,020

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.