go back

Unlisted Face or Jaw Prosthesis Service

Ohio 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?

$1,096

Typical negotiated rate. In Ohio, July 2026.

Insurers have agreed to pay about $1,096 for this service. The price depends on where it is billed: about $0.02 from a physician practice, and about $1,549 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 8 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$0.02$0.02 to $39.81
FacilityA hospital or hospital-owned outpatient department$1,549$708 to $2,455

How much rates vary

Facilitymedian $1,549 · 10th to 90th $219 to $3,981Professionalmedian $0 · 10th to 90th $0 to $50
$0.1$1$10$100$1Kfacility $1,549professional $0

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
Facility
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$218.78
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$2,137.96
Typical High
$3,981.07
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$0.02
Typical High
$0.03
CareSource
Setting
Facility
Modifier
Global
Typical Low
$72,443.60
Median
$72,443.60
Typical High
$72,443.60
Cigna
Setting
Facility
Modifier
Global
Typical Low
$21,379.62
Median
$21,379.62
Typical High
$21,379.62
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$21,379.62
Median
$21,379.62
Typical High
$21,379.62
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$50.12
Typical High
$60.26
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$70.79
Typical High
$75.86
United
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$758.58
Typical High
$2,818.38

Where Ohio 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.

Ohio· 21st of 49

$1,096

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.