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Unlisted Face or Jaw Prosthesis Service

North Carolina 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 $851 · 10th–90th $174$1,9950%10%10th90th$851Professionalmedian $1,549 · 10th–90th $1,549$2,1880%20%40%90th$1,549$100.0$200.0$500.0$1.0K$2.0K

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
$602.56
Median
$602.56
Typical High
$602.56
United
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$891.25
Typical High
$1,995.26
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$56.23
Typical High
$56.23
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$1,548.82
Typical High
$2,187.76