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West Virginia rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.39 / $2.39 / $2.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $2.65 / $3.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.81 / $5.41 / $7.58
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.81 / $3.03 / $10.03
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 / $20.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.84 / $2.16 / $3.60