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Custom Long-Term Palate Covering Appliance

Nationwide rates for HCPCS 21080

Fitting and custom-making of a long-term dental appliance that covers and seals an opening in the roof of the mouth. This is most often needed after surgery to remove part of the palate or upper jaw due to cancer, or to address an opening present from birth, and it is the permanent version of the device made after an initial temporary one has served its purpose.

Rates data updated July 2026.

Facilitymedian $3,981 · 10th–90th $1,479$11,2200%5%10%10th90th$3,981Professionalmedian $1,905 · 10th–90th $1,318$4,3650%20%10th90th$1,905$20.0$200.0$2.0K$20.0K$200.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$1,949.84
Typical High
$5,011.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,698.24
Typical High
$3,467.37
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,398.83
Median
$5,623.41
Typical High
$12,882.50
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,412.54
Median
$2,041.74
Typical High
$3,890.45
Cigna
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$3,630.78
Typical High
$13,803.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,513.56
Median
$2,344.23
Typical High
$4,677.35
United
Setting
Facility
Modifier
Global
Typical Low
$2,290.87
Median
$6,606.93
Typical High
$14,454.40
United
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$1,995.26
Typical High
$3,630.78