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Custom Fitting Of A Surgical Palate-Covering Device

Utah 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?

$2,524

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

Insurers have agreed to pay about $2,524 for this procedure. That total is two separate charges: $1,175 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$1,175$813 to $1,778
Facility feeThe hospital or surgery center$1,349$1,175 to $2,138

How much rates vary

Facilitymedian $1,349 · 10th to 90th $1,175 to $3,631Professionalmedian $1,175 · 10th to 90th $661 to $3,802
$50$100$200$500$1K$2K$5Kfacility $1,349professional $1,175

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
$1,174.90
Median
$1,174.90
Typical High
$1,348.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$1,348.96
Typical High
$4,265.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,122.02
Typical High
$1,548.82
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$1,659.59
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$2,137.96
Median
$2,951.21
Typical High
$4,466.84
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,258.93
Typical High
$2,187.76
Select Health
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$1,819.70
Select Health
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$1,174.90
Typical High
$1,819.70
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,202.26
Typical High
$1,737.80
United
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$4,466.84
Typical High
$5,128.61
United
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$933.25
Typical High
$1,445.44

Where Utah 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

Utah· 29th of 50

$2,524

$1,175 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.