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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 July 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$2,630

Typical negotiated rate. In California, July 2026.

Insurers have agreed to pay about $2,630 for this service. The price depends on where it is billed: about $257 from a physician practice, and about $3,090 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 9 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$257$245 to $257
FacilityA hospital or hospital-owned outpatient department$3,090$851 to $5,888

How much rates vary

Facilitymedian $3,090 · 10th to 90th $83 to $7,586Professionalmedian $257 · 10th to 90th $245 to $631
$100$200$500$1K$2K$5K$10Kfacility $3,090professional $257

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
Aetna
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$257.04
Typical High
$257.04
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,548.82
Median
$3,090.30
Typical High
$7,585.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$0.02
Typical High
$0.02
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$4,168.69
Typical High
$8,709.64
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,691.53
Median
$2,691.53
Typical High
$2,691.53
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$630.96
Typical High
$1,698.24
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$56.23
Typical High
$56.23
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$2,187.76
Typical High
$2,187.76
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$2,691.53
Median
$2,691.53
Typical High
$2,691.53
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$1,584.89
Typical High
$6,456.54

Where California 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.

California· 10th of 49

$2,630

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.