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Arizona rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.11 / $3.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.60 / $3.68 / $4.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $3.70 / $7.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.10 / $3.82 / $4.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $3.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $3.96 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.53 / $1.84 / $3.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $1.84 / $3.05