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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 July 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$4,467

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $4,467 for this service. The price depends on where it is billed: about $398 from a physician practice, and about $4,467 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 4 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$398$398 to $398
FacilityA hospital or hospital-owned outpatient department$4,467$3,090 to $5,888

How much rates vary

Facilitymedian $4,467 · 10th to 90th $2,239 to $9,120Professionalmedian $398 · 10th to 90th $398 to $537
$100$200$500$1K$2K$5K$10Kfacility $4,467professional $398

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
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,630.27
Median
$4,786.30
Typical High
$9,120.11
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$50.12
Typical High
$50.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$34.67
Typical High
$34.67
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$50,118.72
Median
$53,703.18
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$537.03
United
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$2,511.89
Typical High
$4,897.79
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$977.24

Where New York sits

The same service costs 1148.2 times more in Pennsylvania than in Maryland. 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· 3rd of 49

$4,467

PA $54,954MD $47.86

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.