go back

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.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$575

Typical facility fee. In Oklahoma, July 2026.

Insurers have agreed to pay about $575 for this service. Most negotiated rates run $398 to $1,047.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $575 · 10th to 90th $105 to $1,585
$100$200$500$1K$2Kfacility $575

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where Oklahoma sits

The same service costs 1148.2 times more in Pennsylvania than in Maryland. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Oklahoma· 32nd of 49

$575

PA $54,954MD $47.86

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.