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Custom Long-Term Palate Covering Appliance

South Dakota 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.

How much does Custom Long-Term Palate Covering Appliance cost?

$2,818

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $2,818 for this service. The price depends on where it is billed: about $2,818 from a physician practice, and about $2,630 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$2,818$1,698 to $3,467
FacilityA hospital or hospital-owned outpatient department$2,630$2,089 to $3,467

How much rates vary

Facilitymedian $2,630 · 10th to 90th $1,778 to $4,467Professionalmedian $2,818 · 10th to 90th $1,318 to $3,981
$1K$2K$5K$10Kfacility $2,630professional $2,818

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
$1,412.54
Median
$1,412.54
Typical High
$1,778.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,698.24
Typical High
$3,467.37
Avera
Setting
Facility
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$1,737.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2,754.23
Median
$3,890.45
Typical High
$5,011.87
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,905.46
Median
$2,691.53
Typical High
$4,265.80
Medica
Setting
Professional
Modifier
Global
Typical Low
$1,698.24
Median
$4,073.80
Typical High
$12,302.69
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2,951.21
Median
$3,467.37
Typical High
$4,168.69
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2,951.21
Median
$3,467.37
Typical High
$4,265.80
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$2,041.74
Median
$2,691.53
Typical High
$3,311.31
United
Setting
Facility
Modifier
Global
Typical Low
$4,466.84
Median
$4,466.84
Typical High
$6,760.83
United
Setting
Professional
Modifier
Global
Typical Low
$1,659.59
Median
$2,630.27
Typical High
$4,677.35
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$2,454.71
Median
$2,951.21
Typical High
$4,466.84

Where South Dakota sits

The same service costs 2.6 times more in Alaska than in Kentucky. 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.

South Dakota· 6th of 51

$2,818

AK $4,169KY $1,585

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.