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Unlisted Face or Jaw Prosthesis Service

Washington 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?

$646

Typical negotiated rate. In Washington, July 2026.

Insurers have agreed to pay about $646 for this service. The price depends on where it is billed: about $50.12 from a physician practice, and about $741 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$50.12$44.67 to $50.12
FacilityA hospital or hospital-owned outpatient department$741$562 to $933

How much rates vary

Facilitymedian $741 · 10th to 90th $219 to $1,349Professionalmedian $50 · 10th to 90th $45 to $85
$50$100$200$500$1K$2Kfacility $741professional $50

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
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$741.31
Typical High
$1,348.96
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$229.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$758.58
Typical High
$870.96
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$676.08
Typical High
$977.24
Molina
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$50.12
Typical High
$64.57
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$234.42
Typical High
$588.84
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$707.95
Typical High
$1,318.26
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$794.33
Typical High
$1,905.46
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$758.58
Typical High
$758.58

Where Washington 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.

Washington· 28th of 49

$646

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.