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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.

How much rates vary

Facilitymedian $3,236 · 10th to 90th $1,995 to $7,079Professionalmedian $148 · 10th to 90th $148 to $148
$200$500$1K$2K$5K$10Kfacility $3,236professional $148

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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