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Mouthpiece

Maryland rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $11 · 10th–90th $1$150%20%10th90th$11Professionalmedian $3 · 10th–90th $2$40%10%20%10th90th$3$2.0$5.0$10.0$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
$10.72
Median
$10.72
Typical High
$15.14
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.38
Median
$2.75
Typical High
$3.89
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$2.82
Median
$2.82
Typical High
$2.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.82
Typical High
$1.82
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$4.47
Typical High
$6.17
United
Setting
Facility
Modifier
Global
Typical Low
$1.38
Median
$1.78
Typical High
$4.47
United
Setting
Professional
Modifier
Global
Typical Low
$1.78
Median
$2.14
Typical High
$3.63
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$2.04
Median
$2.04
Typical High
$3.80