go back

North Carolina rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.79 / $4.65 / $6.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.31 / $2.93 / $3.79
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $4.33 / $7.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.95 / $6.41 / $7.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.92 / $3.25 / $3.58
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 / $5.71
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $3.79 / $7.39
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.77 / $4.00 / $4.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.23 / $7.12 / $8.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $2.14 / $3.39
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $90.00 / $90.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.47 / $45.93 / $45.93