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Unlisted Face or Jaw Prosthesis Service

Louisiana 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 $427 · 10th–90th $219$1,1480%10%10th90th$427Professionalmedian $138 · 10th–90th $138$1410%20%40%90th$138$200.0$500.0$1.0K$2.0K$5.0K

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
BCBS
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$416.87
Typical High
$676.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$501.19
Typical High
$1,258.93
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$141.25