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Georgia rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.74 / $2.74 / $3.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $2.79 / $3.79
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.33 / $8.03 / $8.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $3.84 / $8.97
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.22 / $3.68 / $6.93
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.68 / $3.68 / $4.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $5.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.90 / $4.33 / $18.13
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.87 / $5.90 / $8.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $2.16 / $3.75