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Unlisted Face or Jaw Prosthesis Service

Nationwide 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.

Facilitymedian $2,239 · 10th–90th $229$6,3100%10%20%10th90th$2,239Professionalmedian $525 · 10th–90th $30$10,0000%10%10th90th$525$0.0$0.5$10.0$200.0$5.0K$100.0K$2.0M

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$912.01
Typical High
$4,466.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$602.56
Typical High
$1,778.28
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,479.11
Median
$3,630.78
Typical High
$7,943.28
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$0.02
Typical High
$0.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$512.86
Typical High
$2,511.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$831.76
Typical High
$2,187.76
United
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$1,023.29
Typical High
$3,388.44
United
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$50.12
Typical High
$138.04