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Unlisted Face or Jaw Prosthesis Service

Rhode Island 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 $537 · 10th to 90th $224 to $3,802
$200$500$1K$2K$5Kfacility $537

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
BCBS
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$380.19
Typical High
$524.81
United
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$1,230.27
Typical High
$5,128.61