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Unlisted Face or Jaw Prosthesis Service

Alabama 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 $145 · 10th–90th $83$1,1750%10%10th90th$145$50.0$100.0$200.0$500.0$1.0K$2.0K

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
BCBS
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$95.50
Typical High
$128.82
United
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$645.65
Typical High
$1,584.89