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Montana rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $1.32 / $3.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.23 / $4.23 / $4.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.01 / $4.55 / $4.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $3.70 / $4.55
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $4.33 / $5.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.21 / $3.91 / $4.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $1.84 / $2.76