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Mouthpiece

California rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $2 · 10th–90th $2$80%20%10th90th$2Professionalmedian $2 · 10th–90th $1$100%20%10th90th$2$0.1$0.2$1.0$5.0$20.0$100.0$500.0

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
$1.15
Median
$1.26
Typical High
$18.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$1.91
Typical High
$5.50
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$3.09
Typical High
$4.47
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.55
Median
$1.95
Typical High
$4.90
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.04
Median
$2.14
Typical High
$5.75
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$4.57
Median
$6.03
Typical High
$9.12
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$4.17
Median
$7.41
Typical High
$13.80
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.47
Median
$3.47
Typical High
$3.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.82
Typical High
$1.82
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$4.68
Typical High
$6.03
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$3.98
Typical High
$10.00
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$45.71
Molina
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$32.36
Typical High
$33.11
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$1.95
Median
$4.47
Typical High
$8.51
Providence
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.82
Typical High
$4.57
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
United
Setting
Facility
Modifier
Global
Typical Low
$0.30
Median
$1.86
Typical High
$2.75
United
Setting
Professional
Modifier
Global
Typical Low
$1.51
Median
$1.95
Typical High
$4.47