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South Carolina 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
$3.46 / $3.46 / $3.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $3.06 / $3.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.33 / $4.33 / $5.41
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 / $3.21
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.74 / $3.77 / $8.24
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.21 / $4.00 / $4.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.00 / $3,000.00 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $1.95 / $2.69