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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 October 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$457

Typical facility fee. In Ohio, October 2026.

Insurers have agreed to pay about $457 for this service. Most negotiated rates run $81.28 to $955.

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 7 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $603 · 10th to 90th $120 to $2,692Professionalmedian $50 · 10th to 90th $30 to $60
$50$100$200$500$1K$2K$5Kfacility $603professional $50

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$371.54
Median
$794.33
Typical High
$3,311.31
CareSource
Setting
Facility
Modifier
None
Typical Low
$79,432.82
Median
$79,432.82
Typical High
$79,432.82
Cigna
Setting
Facility
Modifier
None
Typical Low
$426.58
Median
$588.84
Typical High
$2,691.53
Medical Mutual of Ohio
Setting
Facility
Modifier
None
Typical Low
$426.58
Median
$588.84
Typical High
$2,691.53
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$50.12
Typical High
$60.26
SummaCare
Setting
Professional
Modifier
None
Typical Low
$50.12
Median
$70.79
Typical High
$70.79
United
Setting
Facility
Modifier
None
Typical Low
$97.72
Median
$275.42
Typical High
$2,398.83

Where Ohio 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.

Ohio· 26th of 51

$457

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.