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Custom Fitting Of A Surgical Palate-Covering Device

Pennsylvania 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?

$1,647

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

Insurers have agreed to pay about $1,647 for this procedure. That total is two separate charges: $871 to the doctor who performs it, and $776 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 9 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$871$724 to $1,047
Facility feeThe hospital or surgery center$776$437 to $1,413

How much rates vary

Facilitymedian $776 · 10th to 90th $251 to $4,169Professionalmedian $871 · 10th to 90th $661 to $1,349
$200$500$1K$2K$5Kfacility $776professional $871

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
$707.95
Median
$707.95
Typical High
$870.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$851.14
Typical High
$1,258.93
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$6,456.54
Median
$7,585.78
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$1,096.48
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,122.02
Cigna
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$1,047.13
Typical High
$1,698.24
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,479.11
Typical High
$1,905.46
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,202.26
Typical High
$2,041.74
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$870.96
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$851.14
Typical High
$1,513.56
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$1,148.15
Typical High
$1,202.26
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$309.03
Typical High
$691.83
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$812.83
Typical High
$977.24
United
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$2,818.38
Typical High
$5,248.07
United
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$977.24
Typical High
$1,621.81

Where Pennsylvania 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

Pennsylvania· 47th of 50

$1,647

$871 physician + $776 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.