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Rhode Island rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $870.96 / $2,344.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $851.14 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,412.54 / $1,819.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $4,073.80 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,122.02 / $1,862.09