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Unlisted Face or Jaw Prosthesis Service

Colorado 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 $3,236 · 10th–90th $1,995$7,0790%10%20%10th90th$3,236Professionalmedian $148 · 10th–90th $148$1480%50%100%$148$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,454.71
Median
$3,388.44
Typical High
$8,511.38
United
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$1,479.11
Typical High
$2,691.53
United
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91