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Unlisted Face or Jaw Prosthesis Service

Tennessee 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 $1,072 · 10th–90th $229$2,0420%5%10th90th$1,072Professionalmedian $2,188 · 10th–90th $1,549$2,1880%50%10th$2,188$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
BCBS
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$1,479.11
Typical High
$2,041.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$56.23
Typical High
$1,513.56
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$2,187.76
Typical High
$2,187.76
United
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$794.33
Typical High
$2,137.96