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Unlisted Face or Jaw Prosthesis Service

Florida 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 $2,399 · 10th–90th $1,000$5,2480%5%10%10th90th$2,399Professionalmedian $1,349 · 10th–90th $1,072$1,9950%20%10th90th$1,349$50.0$200.0$1.0K$5.0K

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
Aetna
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$588.84
Typical High
$812.83
AvMed
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$4,897.79
Typical High
$12,302.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$398.11
Typical High
$10,000.00
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$1,548.82
Median
$2,511.89
Typical High
$4,365.16
Molina
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,412.54
Typical High
$1,995.26
United
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$1,445.44
Typical High
$4,168.69
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$39.81
Typical High
$60.26
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,071.52
Typical High
$1,071.52