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Unlisted Face or Jaw Prosthesis Service

Connecticut 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 $3,162 · 10th–90th $1,820$10,4710%20%10th90th$3,162Professionalmedian $54,954 · 10th–90th $0$54,9540%50%10th$54,954$0.0$0.2$2.0$20.0$200.0$2.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,137.96
Median
$3,162.28
Typical High
$10,471.29
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$0.02
Typical High
$0.02
Cigna
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
ConnectiCare
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$501.19
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$54,954.09
Median
$54,954.09
Typical High
$54,954.09
United
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$3,981.07
Typical High
$7,079.46
United
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$64.57
Typical High
$64.57