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New Mexico rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.15 / $3.15 / $3.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.52 / $3.79
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $2.17 / $2.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.60 / $3.46 / $4.12
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 / $3.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.35 / $6.35 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $3.46 / $8.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $3.06 / $5.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.84 / $2.88