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Illinois 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
$2.43 / $2.43 / $4.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.43 / $3.79
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $3.68 / $6.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.80 / $10.93 / $37.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $3.25 / $3.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.76 / $4.76 / $6.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $4.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.11 / $7.91 / $11.52
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.63 / $5.63 / $5.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.33 / $5.89 / $6.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $2.16 / $3.83