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Unlisted Face or Jaw Prosthesis Service

Oklahoma 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 $575 · 10th–90th $105$1,5850%10%10th90th$575$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. Need provider-level prices? Contact us.

Insurance Carrier
Cigna
Setting
Facility
Modifier
Global
Typical Low
$891.25
Median
$891.25
Typical High
$891.25
Medica
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$602.56
Typical High
$1,659.59
United
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$575.44
Typical High
$1,548.82