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Utah 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
$1.37 / $1.37 / $1.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $1.93 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $4.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.96 / $3.17 / $23.45
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.41 / $3.03 / $4.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $1.84 / $3.05