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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 July 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$79.43

Typical facility fee. In Oregon, July 2026.

Insurers have agreed to pay about $79.43 for this service. Most negotiated rates run $79.43 to $589.

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 $794 · 10th to 90th $550 to $4,365Professionalmedian $79 · 10th to 90th $71 to $79
$100$1K$10K$100K$1Mfacility $794professional $79

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
Cigna
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$1,288.25
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$588.84
Typical High
$588.84
Providence
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$851.14
Typical High
$1,659,586.91
Providence
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$79.43
Typical High
$79.43
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$794.33
Typical High
$977.24
United
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$3,311.31
Typical High
$5,128.61

Where Oregon 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.

Oregon· 47th of 49

$79.43

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.