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Custom Fitting Of A Surgical Palate-Covering Device

New Hampshire 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?

$4,099

Typical total for the visit. In New Hampshire, July 2026.

Insurers have agreed to pay about $4,099 for this procedure. That total is two separate charges: $1,148 to the doctor who performs it, and $2,951 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$1,148$955 to $1,514
Facility feeThe hospital or surgery center$2,951$1,698 to $3,388

How much rates vary

Facilitymedian $2,951 · 10th to 90th $1,585 to $3,388Professionalmedian $1,148 · 10th to 90th $776 to $1,995
$1K$2K$5Kfacility $2,951professional $1,148

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
Facility
Modifier
Global
Typical Low
$2,951.21
Median
$2,951.21
Typical High
$3,388.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$954.99
Typical High
$1,148.15
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$1,737.80
Typical High
$3,019.95
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$1,230.27
Typical High
$1,737.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,412.54
Typical High
$2,570.40
Harvard Pilgrim
Setting
Facility
Modifier
Global
Typical Low
$8,709.64
Median
$8,709.64
Typical High
$8,709.64
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$1,288.25
Typical High
$2,137.96
United
Setting
Facility
Modifier
Global
Typical Low
$8,709.64
Median
$8,709.64
Typical High
$8,709.64
United
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,348.96
Typical High
$2,398.83
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$831.76
Typical High
$1,047.13

Where New Hampshire 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

New Hampshire· 12th of 50

$4,099

$1,148 physician + $2,951 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.