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Unlisted Face or Jaw Prosthesis Service

Iowa 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 $692 · 10th–90th $372$2,3440%10%10th90th$692Professionalmedian $151 · 10th–90th $151$1510%50%100%$151$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Medica
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$691.83
Typical High
$2,137.96
United
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$645.65
Typical High
$2,884.03