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Unlisted Face or Jaw Prosthesis Service

New Mexico 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 $468 · 10th–90th $195$1,3800%10%20%10th90th$468Professionalmedian $60 · 10th–90th $45$850%20%40%10th90th$60$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
$169.82
Median
$426.58
Typical High
$691.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$60.26
Typical High
$85.11
United
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$1,096.48
Typical High
$1,445.44