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Oregon rates for HCPCS A4617

Mouth Piece (Special Coverage Instructions Apply. See Cim: 60-4 And Mcm: 3312)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $1.32 / $3.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $1.77 / $1.77
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.46 / $7.81 / $9.53
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.74 / $4.18 / $6.91
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.25 / $4.11 / $4.55
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.44 / $4.23 / $4.76
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.78 / $4.33 / $4.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.60 / $3.80 / $6.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $3.79 / $4.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.68 / $4.76 / $4.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $1.84 / $3.50