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Unlisted Face or Jaw Prosthesis Service

Wisconsin 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?

$2,884

Typical negotiated rate. In Wisconsin, July 2026.

Insurers have agreed to pay about $2,884 for this service. The price depends on where it is billed: about $33.11 from a physician practice, and about $2,884 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 7 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$33.11$32.36 to $70.79
FacilityA hospital or hospital-owned outpatient department$2,884$2,291 to $4,074

How much rates vary

Facilitymedian $2,884 · 10th to 90th $1,380 to $5,754Professionalmedian $33 · 10th to 90th $32 to $2,138
$50$100$200$500$1K$2K$5Kfacility $2,884professional $33

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
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$3,090.30
Typical High
$5,754.40
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$2,238.72
Median
$2,818.38
Typical High
$5,370.32
Medica
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$1,445.44
Typical High
$2,089.30
Medica
Setting
Professional
Modifier
Global
Typical Low
$2,137.96
Median
$2,137.96
Typical High
$2,137.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$933.25
Typical High
$2,344.23
Quartz
Setting
Professional
Modifier
Global
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$2,187.76
United
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$1,479.11
Typical High
$1,949.84

Where Wisconsin 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.

Wisconsin· 8th of 49

$2,884

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.