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New Hampshire 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
$2.27 / $2.27 / $2.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $2.12 / $2.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.12 / $2.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $3.06
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.53 / $3.53 / $10.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $2.87 / $3.53
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.92 / $3.50 / $5.15