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Mouthpiece

Alaska rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $1$70%20%10th90th$4Professionalmedian $4 · 10th–90th $2$50%20%10th90th$4$0.2$1.0$5.0$20.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$8.71
Median
$8.71
Typical High
$8.71
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.86
Median
$3.31
Typical High
$4.37
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.82
Typical High
$1.82
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$1.38
Median
$3.55
Typical High
$6.31
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$4.47
Typical High
$15.14
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.80
Median
$4.27
Typical High
$4.27
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.63
Median
$4.27
Typical High
$4.27
Providence
Setting
Facility
Modifier
Global
Typical Low
$1.38
Median
$3.24
Typical High
$6.46
Providence
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$3.39
Typical High
$60.26
United
Setting
Facility
Modifier
Global
Typical Low
$1.45
Median
$2.14
Typical High
$2.88
United
Setting
Professional
Modifier
Global
Typical Low
$1.51
Median
$2.14
Typical High
$8.13