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Unlisted Face or Jaw Prosthesis Service

West 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.

Facilitymedian $457 · 10th–90th $35$81,2830%20%10th90th$457Professionalmedian $2,188 · 10th–90th $2,188$72,4440%20%40%90th$2,188$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
CareSource
Setting
Facility
Modifier
Global
Typical Low
$81,283.05
Median
$81,283.05
Typical High
$81,283.05
CareSource
Setting
Professional
Modifier
Global
Typical Low
$72,443.60
Median
$72,443.60
Typical High
$72,443.60
Cigna
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$34.67
Typical High
$34.67
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$2,187.76
United
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$457.09
Typical High
$977.24