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Unlisted Face or Jaw Prosthesis Service

Oregon 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?

$178

Typical facility fee. In Oregon, October 2026.

Insurers have agreed to pay about $178 for this service. Most negotiated rates run $79.43 to $912.

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.

How much rates vary

Facilitymedian $871 · 10th to 90th $170 to $251,189Professionalmedian $79 · 10th to 90th $71 to $79
$100$1K$10K$100Kfacility $871professional $79

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

Rates by insurance carrier

Insurance Carrier
Cigna
Setting
Facility
Modifier
None
Typical Low
$549.54
Median
$1,000.00
Typical High
$23,988.33
Cigna
Setting
Professional
Modifier
None
Typical Low
$446.68
Median
$446.68
Typical High
$1,288.25
Pacific Source
Setting
Facility
Modifier
None
Typical Low
$234.42
Median
$234.42
Typical High
$371.54
Providence
Setting
Facility
Modifier
None
Typical Low
$870.96
Median
$251,188.64
Typical High
$275,422.87
Providence
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$79.43
Typical High
$79.43
Regence BlueShield
Setting
Facility
Modifier
None
Typical Low
$602.56
Median
$812.83
Typical High
$912.01
United
Setting
Facility
Modifier
None
Typical Low
$151.36
Median
$295.12
Typical High
$4,897.79

Where Oregon 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.

Oregon· 47th of 51

$178

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.