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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 October 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$661

Typical facility fee. In Iowa, October 2026.

Insurers have agreed to pay about $661 for this service. Most negotiated rates run $417 to $1,148.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $692 · 10th to 90th $158 to $1,820Professionalmedian $151 · 10th to 90th $151 to $151
$100$200$500$1K$2Kfacility $692professional $151

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Hally Health
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Medica
Setting
Facility
Modifier
None
Typical Low
$120.23
Median
$616.60
Typical High
$1,778.28
United
Setting
Facility
Modifier
None
Typical Low
$223.87
Median
$707.95
Typical High
$1,995.26

Where Iowa sits

The same service costs 38.0 times more in New York than in Montana. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Iowa· 17th of 51

$661

NY $3,020MT $79.43

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.