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Unlisted Face or Jaw Prosthesis Service

Louisiana 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?

$347

Typical facility fee. In Louisiana, October 2026.

Insurers have agreed to pay about $347 for this service. Most negotiated rates run $151 to $589.

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 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $355 · 10th to 90th $132 to $1,072Professionalmedian $138 · 10th to 90th $138 to $141
$100$200$500$1K$2Kfacility $355professional $138

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
BCBS Louisiana
Setting
Facility
Modifier
None
Typical Low
$131.83
Median
$251.19
Typical High
$616.60
Cigna
Setting
Facility
Modifier
None
Typical Low
$524.81
Median
$1,000.00
Typical High
$1,584.89
United
Setting
Facility
Modifier
None
Typical Low
$91.20
Median
$354.81
Typical High
$1,202.26
United
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$141.25

Where Louisiana 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.

Louisiana· 34th of 51

$347

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.