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Idaho rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $1.42 / $5.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.23 / $3.23 / $3.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $3.06
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $3.57 / $6.46
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.90 / $4.11 / $4.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.12 / $3.81 / $30.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.03 / $3.03 / $4.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.84 / $5.42