go back

Unlisted Face or Jaw Prosthesis Service

Indiana 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 $4,266 · 10th–90th $2,291$8,3180%20%10th90th$4,266Professionalmedian $0 · 10th–90th $0$00%50%100%$0$0.0$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$2,754.23
Median
$4,365.16
Typical High
$8,317.64
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$0.02
Typical High
$0.02
CareSource
Setting
Facility
Modifier
Global
Typical Low
$60,255.96
Median
$74,131.02
Typical High
$75,857.76
United
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$2,137.96
Typical High
$5,754.40