go back

Missouri rates for HCPCS C2622

Prosthesis, penile, noninflatable

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,768.95 / $3,768.95 / $3,768.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,768.95 / $3,768.95 / $3,768.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,667.60 / $3,768.95 / $7,349.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,371.19 / $2,371.19 / $2,371.19