go back

Oklahoma rates for HCPCS A4617

Mouthpiece

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.58 / $4.84 / $4.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.58 / $3.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $4.33 / $5.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.79 / $3.79 / $3.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $3.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.19 / $3.30 / $9.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $2.06 / $4.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.95 / $3.05