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Alaska rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $3.79 / $4.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $1.77
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.37
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.11 / $4.11 / $6.50
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.79 / $3.79 / $4.23
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.10 / $4.01 / $8.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $3.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $3.60 / $6.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $2.87 / $7.56