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Unlisted Face or Jaw Prosthesis Service

Mississippi 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 $525 · 10th–90th $219$1,4790%10%10th90th$525Professionalmedian $25 · 10th–90th $21$500%20%10th90th$25$20.0$100.0$500.0$2.0K$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
Cigna
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$1,000.00
Typical High
$1,000.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$25.12
Typical High
$50.12
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$524.81
Typical High
$1,479.11