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Maryland rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.33 / $7.33 / $7.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $2.68 / $3.79
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.80 / $2.80 / $2.80
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 / $1.77
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.03 / $4.33 / $6.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.79 / $2.16 / $3.53
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.06 / $2.06 / $2.60