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Unlisted Face or Jaw Prosthesis Service

North Carolina 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?

$251

Typical facility fee. In North Carolina, October 2026.

Insurers have agreed to pay about $251 for this service. Most negotiated rates run $120 to $851.

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 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $251 · 10th to 90th $81 to $2,344Professionalmedian $457 · 10th to 90th $457 to $457
$50$200$1K$5K$20Kfacility $251professional $457

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Cigna
Setting
Facility
Modifier
None
Typical Low
$478.63
Median
$851.14
Typical High
$29,512.09
Medcost
Setting
Professional
Modifier
None
Typical Low
$457.09
Median
$457.09
Typical High
$457.09
United
Setting
Facility
Modifier
None
Typical Low
$77.62
Median
$165.96
Typical High
$1,096.48

Where North Carolina 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.

North Carolina· 40th of 51

$251

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.