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Washington 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
$2.45 / $4.75 / $5.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.45 / $4.24
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.58 / $4.05 / $4.33
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.68 / $90.00 / $90.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.03 / $3.79 / $31.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $3.21
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $4.61 / $10.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.48 / $4.58 / $10.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.33 / $4.33 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.44 / $4.23 / $4.33
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.78 / $4.33 / $4.33
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $3.79 / $3.79
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $4.23 / $4.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.46 / $3.68 / $4.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.84 / $3.50
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.12 / $2.12