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Vermont rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,061.16 / $2,561.44 / $2,963.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,219.80 / $3,497.50 / $5,071.64
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,439.14 / $3,530.30 / $5,071.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,043.39 / $3,535.03 / $9,260.24