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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.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$407

Typical negotiated rate. In Idaho, July 2026.

Insurers have agreed to pay about $407 for this service. The price depends on where it is billed: about $112 from a physician practice, and about $437 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 5 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$112$77.62 to $229
FacilityA hospital or hospital-owned outpatient department$437$275 to $631

How much rates vary

Facilitymedian $437 · 10th to 90th $135 to $955Professionalmedian $112 · 10th to 90th $30 to $372
$50$200$1K$5Kfacility $437professional $112

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where Idaho 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.

Idaho· 40th of 49

$407

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.