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Custom Fitting Of A Surgical Palate-Covering Device

South Dakota 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?

$2,828

Typical total for the visit. In South Dakota, July 2026.

Insurers have agreed to pay about $2,828 for this procedure. That total is two separate charges: $1,479 to the doctor who performs it, and $1,349 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 7 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$1,479$871 to $1,778
Facility feeThe hospital or surgery center$1,349$1,122 to $1,820

How much rates vary

Facilitymedian $1,349 · 10th to 90th $912 to $2,239Professionalmedian $1,479 · 10th to 90th $708 to $2,089
$1K$2K$5Kfacility $1,349professional $1,479

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
$758.58
Median
$758.58
Typical High
$912.01
Aetna
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$870.96
Typical High
$1,778.28
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,479.11
Median
$2,089.30
Typical High
$2,630.27
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,380.38
Typical High
$2,238.72
Medica
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$2,089.30
Typical High
$6,456.54
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,584.89
Median
$1,819.70
Typical High
$2,187.76
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$1,819.70
Typical High
$2,187.76
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,412.54
Typical High
$1,737.80
United
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$3,162.28
United
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,412.54
Typical High
$2,454.71
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$1,621.81
Typical High
$2,344.23

Where South Dakota 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

South Dakota· 21st of 50

$2,828

$1,479 physician + $1,349 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.