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South Carolina rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $3.98
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $3.02 / $4.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.68 / $5.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $6.92 / $6.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $1.78 / $5.13
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $2.51 / $2.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.45 / $4.07 / $9.12
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.45 / $3.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $2.40 / $2.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $2.04 / $3.24