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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.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$3,890

Typical negotiated rate. In Connecticut, July 2026.

Insurers have agreed to pay about $3,890 for this service. The price depends on where it is billed: about $54,954 from a physician practice, and about $3,162 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$54,954$54,954 to $54,954
FacilityA hospital or hospital-owned outpatient department$3,162$2,630 to $6,310

How much rates vary

Facilitymedian $3,162 · 10th to 90th $1,820 to $10,471Professionalmedian $54,954 · 10th to 90th $0 to $54,954
$0.1$1$10$100$1K$10K$100Kfacility $3,162professional $54,954

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. 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
$2,137.96
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

Where Connecticut sits

The same service costs 1148.2 times more in Pennsylvania than in Maryland. 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.

Connecticut· 6th of 49

$3,890

PA $54,954MD $47.86

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.