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New Jersey rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $2.11 / $2.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $2.12 / $3.63
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $2.17 / $3.68
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.85 / $2.85 / $2.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $1.77
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $3.96 / $6.28
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.79 / $2.88 / $2.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.84 / $2.16 / $3.53