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Unlisted Face or Jaw Prosthesis Service

Alaska 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 does Unlisted Face or Jaw Prosthesis Service cost?

$1,175

Typical facility fee. In Alaska, October 2026.

Insurers have agreed to pay about $1,175 for this service. Most negotiated rates run $603 to $251,189.

Few insurers publish rates for this combination, so treat this figure as a rough guide.

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 $1,175 · 10th to 90th $479 to $251,189Professionalmedian $60 · 10th to 90th $60 to $60
$100$1K$10K$100Kfacility $1,175professional $60

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
Moda Health
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$60.26
Typical High
$60.26
Providence
Setting
Facility
Modifier
None
Typical Low
$251,188.64
Median
$251,188.64
Typical High
$346,736.85
Providence
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$60.26
Typical High
$60.26
United
Setting
Facility
Modifier
None
Typical Low
$478.63
Median
$954.99
Typical High
$1,174.90

Where Alaska sits

The same service costs 38.0 times more in New York than in Montana. 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.

Alaska· 11th of 51

$1,175

NY $3,020MT $79.43

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.