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Kentucky 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
$2.22 / $2.54 / $5.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.31 / $2.54 / $3.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.21 / $3.90
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.25 / $6.06 / $7.14
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.33 / $5.41 / $7.14
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 / $11.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.63 / $45.00 / $45.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $2.16 / $3.46