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Custom Fitting Of A Surgical Palate-Covering Device

Montana rates for HCPCS 21076

This is the process of taking impressions and custom-designing a prosthetic device that covers and seals an opening in the roof of the mouth, made to be placed at the time of surgery such as after removal of a tumor. It helps the patient speak, swallow, and eat normally while the surgical area heals.

Rates data updated July 2026.

How much does Custom Fitting Of A Surgical Palate-Covering Device cost?

$2,643

Typical total for the visit. In Montana, July 2026.

Insurers have agreed to pay about $2,643 for this procedure. That total is two separate charges: $1,230 to the doctor who performs it, and $1,413 to the hospital or surgery center where it takes place. Done somewhere without a facility charge, you pay only the first.

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 6 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$1,230$1,000 to $1,413
Facility feeThe hospital or surgery center$1,413$1,202 to $1,514

How much rates vary

Facilitymedian $1,413 · 10th to 90th $1,202 to $1,698Professionalmedian $1,230 · 10th to 90th $741 to $1,738
$100$200$500$1K$2K$5Kfacility $1,413professional $1,230

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
$660.69
Median
$1,000.00
Typical High
$3,801.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,348.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,096.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,148.15
Typical High
$1,659.59
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,479.11
Typical High
$1,659.59
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,479.11
Typical High
$1,659.59
Providence
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$1,258.93
Typical High
$1,778.28
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$1,148.15
Typical High
$1,737.80
United
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$3,162.28
United
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,380.38
Typical High
$1,698.24

Where Montana sits

The same service costs 6.8 times more in Indiana than in Delaware. 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.

Physician feeFacility fee

Montana· 25th of 50

$2,643

$1,230 physician + $1,413 facility

IN $8,794DE $1,299

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.