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Rhode Island rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,187.76 / $5,888.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,089.30 / $3,801.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $3,548.13 / $4,365.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $7,413.10 / $13,182.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,818.38 / $4,677.35