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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 October 2026.

How much does Unlisted Face or Jaw Prosthesis Service cost?

$302

Typical negotiated rate. In South Carolina, October 2026.

Insurers have agreed to pay about $302 for this service. The price depends on where it is billed: about $30.20 from a physician practice, and about $380 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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$30.20$30.20 to $30.20
FacilityA hospital or hospital-owned outpatient department$380$214 to $661

How much rates vary

Facilitymedian $380 · 10th to 90th $112 to $1,622Professionalmedian $30 · 10th to 90th $30 to $100
$50$100$200$500$1K$2Kfacility $380professional $30

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
BCBS South Carolina
Setting
Facility
Modifier
None
Typical Low
$181.97
Median
$302.00
Typical High
$524.81
BCBS South Carolina
Setting
Professional
Modifier
None
Typical Low
$691.83
Median
$691.83
Typical High
$691.83
Cigna
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$794.33
Typical High
$1,905.46
Cigna
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$120.23
Typical High
$144.54
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
None
Typical Low
$83.18
Median
$446.68
Typical High
$2,238.72

Where South 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.

South Carolina· 38th of 51

$302

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.