go back

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 July 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$427

Typical facility fee. In Louisiana, July 2026.

Insurers have agreed to pay about $427 for this service. Most negotiated rates run $339 to $661.

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 $427 · 10th to 90th $219 to $1,148Professionalmedian $138 · 10th to 90th $138 to $141
$200$500$1K$2Kfacility $427professional $138

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
$229.09
Median
$416.87
Typical High
$676.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$501.19
Typical High
$1,258.93
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$141.25

Where Louisiana 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.

Louisiana· 38th of 49

$427

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.