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Rhode Island rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,708.85 / $2,681.19 / $3,780.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,776.70 / $2,185.32 / $4,711.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,267.67 / $3,728.76 / $4,361.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,219.00 / $7,228.00 / $12,680.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,919.57 / $3,161.50 / $4,914.38