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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 July 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$355

Typical negotiated rate. In Texas, July 2026.

Insurers have agreed to pay about $355 for this service. The price depends on where it is billed: about $30.20 from a physician practice, and about $363 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$30.20$30.20 to $30.20
FacilityA hospital or hospital-owned outpatient department$363$214 to $661

How much rates vary

Facilitymedian $363 · 10th to 90th $117 to $1,995Professionalmedian $30 · 10th to 90th $30 to $759
$50$100$200$500$1K$2K$5Kfacility $363professional $30

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
$588.84
Median
$3,981.07
Typical High
$4,466.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$338.84
Typical High
$724.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$56.23
Typical High
$56.23
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$2,187.76
Typical High
$2,187.76
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$758.58
Typical High
$2,290.87
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$758.58
Typical High
$758.58

Where Texas 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.

Texas· 42nd of 49

$355

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.