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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 October 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$437

Typical facility fee. In Arizona, October 2026.

Insurers have agreed to pay about $437 for this service. Most negotiated rates run $398 to $1,072.

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 4 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $617 · 10th to 90th $234 to $2,344Professionalmedian $398 · 10th to 90th $398 to $646
$100$200$500$1K$2Kfacility $617professional $398

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

Rates by insurance carrier

Insurance Carrier
BCBS Arizona
Setting
Facility
Modifier
None
Typical Low
$416.87
Median
$977.24
Typical High
$2,570.40
BCBS Arizona
Setting
Professional
Modifier
None
Typical Low
$398.11
Median
$398.11
Typical High
$630.96
Cigna
Setting
Facility
Modifier
None
Typical Low
$616.60
Median
$2,089.30
Typical High
$2,691.53
Medica
Setting
Facility
Modifier
None
Typical Low
$177.83
Median
$371.54
Typical High
$1,949.84
Medica
Setting
Professional
Modifier
None
Typical Low
$2,137.96
Median
$2,137.96
Typical High
$2,137.96
United
Setting
Facility
Modifier
None
Typical Low
$177.83
Median
$524.81
Typical High
$2,238.72

Where Arizona 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.

Arizona· 28th of 51

$437

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.