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California rates for HCPCS A4617

Mouth Piece (Special Coverage Instructions Apply. See Cim: 60-4 And Mcm: 3312)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $1.27 / $12.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $1.39 / $3.79
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $3.68 / $6.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.49 / $1.80 / $4.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.06 / $2.12 / $4.03
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.55 / $5.93 / $9.16
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.44 / $9.69 / $16.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.44 / $3.44 / $3.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $3.59
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.46 / $4.33 / $5.85
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.60 / $3.90 / $8.44
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $90.00 / $90.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.47 / $44.16 / $45.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.35 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $4.33 / $6.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $4.88
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.17 / $8.17 / $8.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.84 / $4.33