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Unlisted Face or Jaw Prosthesis Service

Georgia 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 $741$3,9810%5%10%10th90th$2,239Professionalmedian $275 · 10th–90th $275$2750%50%100%$275$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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

Insurance Carrier
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$2,344.23
Typical High
$4,168.69
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,511.89
Median
$2,511.89
Typical High
$2,511.89
United
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$1,318.26
Typical High
$2,454.71