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Unlisted Face or Jaw Prosthesis Service

Idaho 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 $437 · 10th–90th $135$9550%10%10th90th$437Professionalmedian $112 · 10th–90th $30$3720%20%10th90th$112$50.0$200.0$1.0K$5.0K

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
BCBS
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$371.54
Typical High
$724.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$229.09
Typical High
$371.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$77.62
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$549.54
Typical High
$794.33
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$112.20
Select Health
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$371.54
Typical High
$588.84
Select Health
Setting
Professional
Modifier
Global
Typical Low
$8,511.38
Median
$8,511.38
Typical High
$8,511.38
United
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$1,819.70
Typical High
$9,332.54