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Unlisted Face or Jaw Prosthesis Service

South 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?

$468

Typical negotiated rate. In South Carolina, July 2026.

Insurers have agreed to pay about $468 for this service. The price depends on where it is billed: about $1,778 from a physician practice, and about $389 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 5 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$1,778$1,778 to $1,778
FacilityA hospital or hospital-owned outpatient department$389$224 to $537

How much rates vary

Facilitymedian $389 · 10th to 90th $174 to $1,202Professionalmedian $1,778 · 10th to 90th $30 to $1,778
$50$100$200$500$1K$2K$5Kfacility $389professional $1,778

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
$1,778.28
Median
$1,778.28
Typical High
$1,778.28
BCBS
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$331.13
Typical High
$501.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$891.25
Median
$891.25
Typical High
$891.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$120.23
Typical High
$144.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$1,122.02
Typical High
$4,677.35

Where South 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.

South Carolina· 35th of 49

$468

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.