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Mouthpiece

Massachusetts rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $2$890%20%10th90th$4Professionalmedian $3 · 10th–90th $2$40%20%10th90th$3$1.0$10.0$100.0$1.0K$10.0K

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
$1.91
Median
$1.91
Typical High
$1.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$2.40
Typical High
$4.07
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$3.80
Median
$4.27
Typical High
$89.13
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$1.78
Median
$3.02
Typical High
$45.71
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.01
Median
$5.01
Typical High
$5.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.82
Typical High
$2.75
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$87.10
Typical High
$7,079.46
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$3.55
Median
$3.80
Typical High
$3.80
Health New England
Setting
Professional
Modifier
Global
Typical Low
$2.24
Median
$2.24
Typical High
$2.24
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$3.80
Median
$4.27
Typical High
$89.13
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$1.78
Median
$3.02
Typical High
$45.71
United
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$2.19
Typical High
$4.47
United
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$3.80
Typical High
$4.47