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Unlisted Face or Jaw Prosthesis Service

Illinois 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.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$372

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $372 for this service. The price depends on where it is billed: about $347 from a physician practice, and about $407 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 5 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$347$151 to $347
FacilityA hospital or hospital-owned outpatient department$407$295 to $851

How much rates vary

Facilitymedian $407 · 10th to 90th $204 to $1,820Professionalmedian $347 · 10th to 90th $120 to $1,995
$100$200$500$1K$2K$5K$10Kfacility $407professional $347

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
BCBS
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$338.84
Typical High
$416.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$10,000.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$199.53
Typical High
$346.74
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$1,513.56
Median
$1,995.26
Typical High
$2,511.89
United
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$645.65
Typical High
$2,089.30

Where Illinois sits

The same service costs 1148.2 times more in Pennsylvania than in Maryland. 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.

Illinois· 41st of 49

$372

PA $54,954MD $47.86

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.