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Minnesota 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
$2.76 / $2.76 / $2.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $1.42 / $3.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $4.62 / $6.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.46 / $4.11 / $4.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.97 / $15.19 / $37.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $5.22 / $6.19
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.75 / $12.78 / $29.41
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $4.88 / $5.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $4.33 / $12.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $2.04 / $5.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $2.04 / $6.13