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Unlisted Face or Jaw Prosthesis Service

Texas 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?

$589

Typical negotiated rate. In Texas, October 2026.

Insurers have agreed to pay about $589 for this service. The price depends on where it is billed: about $759 from a physician practice, and about $550 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$759$30.20 to $759
FacilityA hospital or hospital-owned outpatient department$550$263 to $1,445

How much rates vary

Facilitymedian $550 · 10th to 90th $162 to $2,692Professionalmedian $759 · 10th to 90th $30 to $759
$100$1K$10K$100Kfacility $550professional $759

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
BCBS Texas
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$371.54
Typical High
$1,096.48
Cigna
Setting
Facility
Modifier
None
Typical Low
$630.96
Median
$1,258.93
Typical High
$2,691.53
Lucent Health
Setting
Professional
Modifier
None
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$2,187.76
Moda Health
Setting
Facility
Modifier
None
Typical Low
$588.84
Median
$3,981.07
Typical High
$6,456.54
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Providence
Setting
Facility
Modifier
None
Typical Low
$724.44
Median
$1,995.26
Typical High
$251,188.64
Providence
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$60.26
Typical High
$79.43
United
Setting
Facility
Modifier
None
Typical Low
$141.25
Median
$741.31
Typical High
$2,187.76
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$758.58
Median
$758.58
Typical High
$758.58

Where Texas 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.

Texas· 19th of 51

$589

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.