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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 October 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$2,630

Typical facility fee. In Colorado, October 2026.

Insurers have agreed to pay about $2,630 for this service. Most negotiated rates run $1,148 to $3,548.

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 $2,630 · 10th to 90th $407 to $5,129Professionalmedian $155 · 10th to 90th $148 to $347
$200$500$1K$2K$5K$10Kfacility $2,630professional $155

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
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$2,137.96
Median
$3,311.31
Typical High
$5,370.32
Cigna
Setting
Facility
Modifier
None
Typical Low
$645.65
Median
$2,290.87
Typical High
$4,786.30
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$154.88
Typical High
$346.74
United
Setting
Facility
Modifier
None
Typical Low
$239.88
Median
$616.60
Typical High
$1,905.46
United
Setting
Professional
Modifier
None
Typical Low
$147.91
Median
$147.91
Typical High
$147.91

Where Colorado 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.

Colorado· 2nd of 51

$2,630

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.