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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 October 2026.

How much rates vary

Facilitymedian $132 · 10th to 90th $35 to $661Professionalmedian $2,188 · 10th to 90th $2,188 to $2,188
$50$100$200$500$1K$2Kfacility $132professional $2,188

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Cigna
Setting
Facility
Modifier
None
Typical Low
$34.67
Median
$34.67
Typical High
$34.67
Cigna
Setting
Professional
Modifier
None
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$2,187.76
United
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$131.83
Typical High
$660.69