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Hawaii rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.89 / $3.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.44 / $3.44 / $3.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $3.06 / $5.17
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.33 / $4.53 / $4.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.03 / $4.33 / $6.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $3.34 / $5.40
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.49 / $3.61 / $4.12