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Unlisted Face or Jaw Prosthesis Service

Missouri 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 $4,169 · 10th–90th $813$7,7620%10%10th90th$4,169Professionalmedian $724 · 10th–90th $724$2,1380%20%40%90th$724$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
$2,238.72
Median
$4,570.88
Typical High
$8,317.64
Cigna
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$724.44
Medica
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$616.60
Typical High
$1,288.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$2,137.96
Median
$2,137.96
Typical High
$2,137.96
United
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$691.83
Typical High
$1,513.56