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Unlisted Face or Jaw Prosthesis Service

Arizona 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?

$1,230

Typical facility fee. In Arizona, July 2026.

Insurers have agreed to pay about $1,230 for this service. Most negotiated rates run $513 to $1,995.

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 $1,549 · 10th to 90th $417 to $2,884Professionalmedian $490 · 10th to 90th $398 to $933
$200$500$1K$2Kfacility $1,549professional $490

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
BCBS
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$1,862.09
Typical High
$3,467.37
BCBS
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$489.78
Typical High
$933.25
Medica
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$1,412.54
Typical High
$2,238.72
Medica
Setting
Professional
Modifier
Global
Typical Low
$2,137.96
Median
$2,137.96
Typical High
$2,137.96
United
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$1,047.13
Typical High
$2,137.96

Where Arizona 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.

Arizona· 17th of 49

$1,230

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.