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Mouthpiece

Oklahoma rates for HCPCS A4617

Mouthpiece

Rates data updated October 2026.

How much does Mouthpiece cost?

$2.63

Typical negotiated rate. In Oklahoma, October 2026.

Insurers have agreed to pay about $2.63 for this service. Most negotiated rates run $1.82 to $3.80.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $3 · 10th to 90th $3 to $89Professionalmedian $3 · 10th to 90th $2 to $45
$0.2$1$5$20$100facility $3professional $3

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$2.57
Median
$2.57
Typical High
$2.57
Aetna
Setting
Professional
Modifier
None
Typical Low
$2.51
Median
$2.57
Typical High
$2.57
Ambetter
Setting
Professional
Modifier
None
Typical Low
$2.63
Median
$3.09
Typical High
$3.31
BCBS Oklahoma
Setting
Professional
Modifier
None
Typical Low
$3.80
Median
$3.80
Typical High
$3.80
Cigna
Setting
Professional
Modifier
None
Typical Low
$1.82
Median
$1.82
Typical High
$1.82
Medica
Setting
Facility
Modifier
None
Typical Low
$2.63
Median
$2.69
Typical High
$89.13
Medica
Setting
Professional
Modifier
None
Typical Low
$1.23
Median
$4.27
Typical High
$44.67
United
Setting
Professional
Modifier
None
Typical Low
$1.23
Median
$1.51
Typical High
$3.02
1 more rate with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Ambetter
Setting
Professional
Modifier
KX · Policy requirements met
Typical Low
$2.69
Median
$2.69
Typical High
$2.69

Where Oklahoma sits

The same service costs 2.6 times more in Hawaii than in California. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Oklahoma· 28th of 51

$2.63

HI $4.79CA $1.82

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.