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Unlisted Face or Jaw Prosthesis Service

Nevada 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 $2,239 · 10th–90th $1,047$4,4670%20%10th90th$2,239Professionalmedian $50 · 10th–90th $31$5,0120%20%10th90th$50$50.0$100.0$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
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,513.56
Median
$3,467.37
Typical High
$4,466.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$707.95
Typical High
$912.01
Select Health
Setting
Professional
Modifier
Global
Typical Low
$5,011.87
Median
$5,011.87
Typical High
$5,128.61
United
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$1,047.13
Typical High
$2,041.74
United
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$30.90
Typical High
$50.12