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Arkansas rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.49 / $3.49 / $3.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.50 / $3.60
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $6.67 / $6.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $519,999.48 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.74 / $4.95 / $5.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.33 / $4.33 / $4.33
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.33 / $4.33 / $4.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.14 / $1.14 / $1.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $1.77 / $3.21
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.67 / $7.67 / $7.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $2.04 / $2.98