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Massachusetts 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
$1.89 / $1.89 / $1.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.11 / $3.15
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.92 / $8.86 / $90.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.84 / $3.12 / $7.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.88 / $1.88 / $2.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.00 / $5.00 / $5.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $4.88
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.92 / $2.92 / $2.92
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.53 / $3.53 / $3.53
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.86 / $90.00 / $90.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $2.19 / $45.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.84 / $3.53 / $4.23