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Unlisted Face or Jaw Prosthesis Service

Kentucky 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?

$120

Typical negotiated rate. In Kentucky, October 2026.

Insurers have agreed to pay about $120 for this service. The price depends on where it is billed: about $44.67 from a physician practice, and about $417 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$44.67$44.67 to $2,188
FacilityA hospital or hospital-owned outpatient department$417$115 to $832

How much rates vary

Facilitymedian $417 · 10th to 90th $59 to $3,388Professionalmedian $45 · 10th to 90th $45 to $79,433
$100$1K$10K$100Kfacility $417professional $45

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

Rates by insurance carrier

Insurance Carrier
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$575.44
Median
$3,801.89
Typical High
$11,220.18
CareSource
Setting
Facility
Modifier
None
Typical Low
$81,283.05
Median
$81,283.05
Typical High
$81,283.05
CareSource
Setting
Professional
Modifier
None
Typical Low
$66,069.34
Median
$79,432.82
Typical High
$87,096.36
Cigna
Setting
Facility
Modifier
None
Typical Low
$34.67
Median
$467.74
Typical High
$794.33
Cigna
Setting
Professional
Modifier
None
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$2,187.76
Molina
Setting
Professional
Modifier
None
Typical Low
$44.67
Median
$44.67
Typical High
$48.98
United
Setting
Facility
Modifier
None
Typical Low
$70.79
Median
$186.21
Typical High
$1,148.15

Where Kentucky 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.

Kentucky· 49th of 51

$120

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.