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New York rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $2.11 / $4.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.27 / $4.09
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $2.17 / $5.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $2.12 / $5.23
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.36 / $3.61 / $3.61
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.61 / $3.61 / $3.61
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 / $3.21
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.98 / $21.52 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $4.33 / $7.89
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.90 / $3.08 / $3.61
Fidelis
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $4.55 / $4.55
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $555.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $6.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $2.16 / $3.96
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.90 / $2.90 / $5.00
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.90 / $2.90 / $3.08