go back

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 July 2026.

Facilitymedian $10,715 · 10th–90th $724$66,0690%20%40%10th90th$10,715Professionalmedian $2,188 · 10th–90th $0$85,1140%20%10th90th$2,188$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
$3,801.89
Median
$10,715.19
Typical High
$11,220.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$0.02
Typical High
$0.02
CareSource
Setting
Facility
Modifier
Global
Typical Low
$66,069.34
Median
$85,113.80
Typical High
$114,815.36
CareSource
Setting
Professional
Modifier
Global
Typical Low
$63,095.73
Median
$79,432.82
Typical High
$97,723.72
Cigna
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$34.67
Typical High
$34.67
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$2,187.76
Molina
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$44.67
Typical High
$67.61
United
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$724.44
Typical High
$1,949.84