go back

Missouri rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.85 / $3.02 / $4.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $2.43 / $4.33
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $4.15 / $4.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.18 / $4.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $1.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $4.30 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.53 / $2.16 / $6.60
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.67 / $7.67 / $7.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $2.16 / $3.84