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Unlisted Face or Jaw Prosthesis Service

Maryland 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 $41 · 10th–90th $36$6460%10%20%10th90th$41Professionalmedian $1,380 · 10th–90th $1,380$1,3800%50%100%$1,380$50.0$100.0$200.0$500.0$1.0K

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
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$645.65
United
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$40.74
Typical High
$128.82