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Custom Appliance After Lower Jaw Removal

Pennsylvania rates for HCPCS 21081

Takes impressions of the mouth and builds a custom-made appliance for someone who has had part of the lower jaw removed. The device supports the remaining jaw in a workable position and helps restore chewing, speech, and the shape of the lower face. It is made individually in a dental laboratory and fitted and adjusted over a series of visits.

Rates data updated July 2026.

How much does Custom Appliance After Lower Jaw Removal cost?

$1,514

Typical physician fee. In Pennsylvania, July 2026.

Insurers have agreed to pay about $1,514 for this service. Most negotiated rates run $1,288 to $1,820.

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 9 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $1,514 · 10th to 90th $1,122 to $2,344
$1K$2K$5Kprofessional $1,514

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
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,479.11
Typical High
$2,137.96
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$1,737.80
Typical High
$1,862.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,819.70
Typical High
$3,019.95
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,905.46
Median
$2,570.40
Typical High
$3,235.94
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$1,584.89
Median
$2,089.30
Typical High
$4,897.79
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,513.56
Typical High
$2,630.27
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$2,041.74
Median
$2,137.96
Typical High
$2,290.87
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,445.44
Typical High
$1,584.89
United
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,698.24
Typical High
$2,818.38

Where Pennsylvania sits

The same service costs 2.7 times more in Alaska than in Kentucky. 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.

Pennsylvania· 44th of 51

$1,514

AK $3,802KY $1,413

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.