Unlisted Face or Jaw Prosthesis Service

South Dakota 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?

$224

Typical facility fee. In South Dakota, October 2026.

Insurers have agreed to pay about $224 for this service. Most negotiated rates run $126 to $479.

Few insurers publish rates for this combination, so treat this figure as a rough guide.

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 $126 · 10th to 90th $126 to $224Professionalmedian $479 · 10th to 90th $479 to $479

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	Facility/Professional	Modifier	Typical Low	Median	Typical High
Medica Setting Facility Modifier None Typical Low $125.89 Median $125.89 Typical High $223.87	Facility	None	$125.89	$125.89	$223.87
Sanford Health Plan Setting Professional Modifier None Typical Low $478.63 Median $478.63 Typical High $478.63	Professional	None	$478.63	$478.63	$478.63
United Setting Facility Modifier None Typical Low $125.89 Median $125.89 Typical High $223.87	Facility	None	$125.89	$125.89	$223.87

Where South Dakota 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 Dakota· 42nd of 51

$224

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.