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?
$398
Typical facility fee. In Rhode Island, October 2026.
Insurers have agreed to pay about $398 for this service. Most negotiated rates run $158 to $676.
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 3 insurance carriers under federal price transparency rules.
How much rates vary
Facilitymedian $398 · 10th to 90th $112 to $1,660
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
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
BCBS Rhode Island
Setting
Facility
Modifier
None
Typical Low
$165.96
Median
$380.19
Typical High
$524.81
Facility
None
$165.96
$380.19
$524.81
Cigna
Setting
Facility
Modifier
None
Typical Low
$50.12
Median
$676.08
Typical High
$1,202.26
Facility
None
$50.12
$676.08
$1,202.26
United
Setting
Facility
Modifier
None
Typical Low
$97.72
Median
$316.23
Typical High
$3,890.45
Facility
None
$97.72
$316.23
$3,890.45
1 more rate with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
Insurance Carrier
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
BCBS Rhode Island
Setting
Professional
Modifier
ET · Emergency service
Typical Low
$85.11
Median
$85.11
Typical High
$100.00
Professional
ET · Emergency service
$85.11
$85.11
$100.00
Where Rhode Island 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.