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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 October 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$347

Typical negotiated rate. In Washington, October 2026.

Insurers have agreed to pay about $347 for this service. The price depends on where it is billed: about $48.98 from a physician practice, and about $646 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$48.98$44.67 to $50.12
FacilityA hospital or hospital-owned outpatient department$646$302 to $871

How much rates vary

Facilitymedian $646 · 10th to 90th $145 to $1,175Professionalmedian $49 · 10th to 90th $45 to $76
$50$100$200$500$1K$2K$5Kfacility $646professional $49

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
Asuris Northwest Health
Setting
Facility
Modifier
None
Typical Low
$426.58
Median
$794.33
Typical High
$1,412.54
Asuris Northwest Health
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$2,187.76
Typical High
$2,187.76
Cigna
Setting
Facility
Modifier
None
Typical Low
$707.95
Median
$776.25
Typical High
$2,137.96
Molina
Setting
Professional
Modifier
None
Typical Low
$44.67
Median
$48.98
Typical High
$50.12
Regence BlueShield
Setting
Facility
Modifier
None
Typical Low
$478.63
Median
$707.95
Typical High
$1,348.96
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
United
Setting
Facility
Modifier
None
Typical Low
$134.90
Median
$346.74
Typical High
$954.99
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$758.58
Median
$758.58
Typical High
$758.58

Where Washington 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.

Washington· 33rd of 51

$347

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.