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Virginia 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
$2.68 / $2.68 / $2.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $2.68 / $3.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.12 / $2.65
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.80 / $2.80 / $2.80
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 / $1.77
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.25 / $4.33 / $5.54
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.44 / $3.25 / $6.22
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $6.00 / $8.38
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.05 / $4.07 / $8.97
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.05 / $4.07 / $8.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.84 / $2.16 / $3.59