go back

Unlisted Face or Jaw Prosthesis Service

California 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?

$1,318

Typical negotiated rate. In California, October 2026.

Insurers have agreed to pay about $1,318 for this service. The price depends on where it is billed: about $2,188 from a physician practice, and about $1,259 from a hospital or other facility.

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 9 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$2,188$631 to $2,188
FacilityA hospital or hospital-owned outpatient department$1,259$339 to $5,754

How much rates vary

Facilitymedian $1,259 · 10th to 90th $126 to $151,356Professionalmedian $2,188 · 10th to 90th $79 to $2,188
$100$1K$10K$100Kfacility $1,259professional $2,188

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
Aetna
Setting
Professional
Modifier
None
Typical Low
$3,388.44
Median
$3,388.44
Typical High
$3,388.44
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$3,235.94
Median
$4,786.30
Typical High
$6,606.93
Blue Shield
Setting
Facility
Modifier
None
Typical Low
$72.44
Median
$3,548.13
Typical High
$8,511.38
Cigna
Setting
Facility
Modifier
None
Typical Low
$457.09
Median
$912.01
Typical High
$10,000.00
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$407.38
Median
$630.96
Typical High
$831.76
Lucent Health
Setting
Professional
Modifier
None
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$2,187.76
Optum
Setting
Professional
Modifier
None
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
None
Typical Low
$676.08
Median
$151,356.12
Typical High
$251,188.64
Providence
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
United
Setting
Facility
Modifier
None
Typical Low
$123.03
Median
$489.78
Typical High
$3,090.30

Where California 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.

California· 8th of 51

$1,318

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.