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Unlisted Face or Jaw Prosthesis Service

Tennessee 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 facility fee. In Tennessee, July 2026.

Insurers have agreed to pay about $1,096 for this service. Most negotiated rates run $525 to $1,585.

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 4 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $1,072 · 10th to 90th $229 to $2,042Professionalmedian $2,188 · 10th to 90th $1,549 to $2,188
$100$200$500$1K$2K$5Kfacility $1,072professional $2,188

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
$691.83
Median
$1,479.11
Typical High
$2,041.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$56.23
Typical High
$1,513.56
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$2,187.76
Typical High
$2,187.76
United
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$794.33
Typical High
$2,137.96

Where Tennessee 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.

Tennessee· 22nd 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.