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Custom Fitting Of A Surgical Palate-Covering Device

Virginia 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?

$2,034

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

Insurers have agreed to pay about $2,034 for this procedure. That total is two separate charges: $912 to the doctor who performs it, and $1,122 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 8 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$912$832 to $1,175
Facility feeThe hospital or surgery center$1,122$912 to $1,738

How much rates vary

Facilitymedian $1,122 · 10th to 90th $741 to $3,890Professionalmedian $912 · 10th to 90th $708 to $1,514
$1K$2K$5K$10Kfacility $1,122professional $912

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
$912.01
Typical High
$1,479.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$891.25
Typical High
$1,174.90
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,090.30
Median
$3,981.07
Typical High
$4,466.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,000.00
Typical High
$1,737.80
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$912.01
Typical High
$3,548.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$645.65
Typical High
$645.65
Cigna
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,122.02
Typical High
$1,862.09
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,122.02
Typical High
$1,348.96
Medcost
Setting
Professional
Modifier
Global
Typical Low
$1,412.54
Median
$1,737.80
Typical High
$1,995.26
Medcost
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$1,122.02
Typical High
$1,737.80
Medcost
Setting
Professional
Modifier
Global
Typical Low
$1,348.96
Median
$1,348.96
Typical High
$1,348.96
Sentara
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$1,071.52
Typical High
$3,630.78
Sentara
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,258.93
Typical High
$3,630.78
United
Setting
Facility
Modifier
Global
Typical Low
$1,737.80
Median
$3,311.31
Typical High
$5,754.40
United
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$1,071.52
Typical High
$1,737.80

Where Virginia 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

Virginia· 41st of 50

$2,034

$912 physician + $1,122 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.