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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 July 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$891

Typical facility fee. In North Carolina, July 2026.

Insurers have agreed to pay about $891 for this service. Most negotiated rates run $479 to $1,175.

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 $851 · 10th to 90th $174 to $1,995Professionalmedian $1,549 · 10th to 90th $1,549 to $2,188
$100$200$500$1K$2Kfacility $851professional $1,549

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. 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
Global
Typical Low
$602.56
Median
$602.56
Typical High
$602.56
United
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$891.25
Typical High
$1,995.26
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$56.23
Typical High
$56.23
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$1,548.82
Typical High
$2,187.76

Where North Carolina 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.

North Carolina· 23rd of 49

$891

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.