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Unlisted Face or Jaw Prosthesis Service

Virginia 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?

$1,660

Typical facility fee. In Virginia, July 2026.

Insurers have agreed to pay about $1,660 for this service. Most negotiated rates run $1,148 to $2,570.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $1,660 · 10th to 90th $347 to $10,000Professionalmedian $1,660 · 10th to 90th $933 to $10,000
$200$500$1K$2K$5K$10Kfacility $1,660professional $1,660

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
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,137.96
Median
$2,570.40
Typical High
$2,951.21
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$1,995.26
Typical High
$2,754.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$645.65
Typical High
$645.65
Sentara
Setting
Facility
Modifier
Global
Typical Low
$933.25
Median
$1,479.11
Typical High
$10,964.78
Sentara
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,479.11
Typical High
$10,964.78
United
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$1,096.48
Typical High
$2,454.71

Where Virginia 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.

Virginia· 14th of 49

$1,660

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.