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Louisiana rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $3.06 / $3.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.77 / $3.60
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $4.33 / $8.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.77 / $6.44 / $9.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.68 / $2.68
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $4.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $2.06 / $3.39