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Mouthpiece

Michigan rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $2$190%10%20%10th90th$4Professionalmedian $3 · 10th–90th $1$40%10%20%10th90th$3$0.1$0.2$1.0$5.0$20.0$100.0

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
$3.31
Median
$3.31
Typical High
$3.31
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$2.69
Typical High
$3.72
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$2.19
Median
$3.09
Typical High
$8.51
BCBS
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$11.75
Typical High
$23.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$4.07
Median
$4.37
Typical High
$4.57
CareSource
Setting
Facility
Modifier
Global
Typical Low
$2.82
Median
$2.82
Typical High
$2.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$3.55
Typical High
$4.90
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$0.23
Median
$3.02
Typical High
$9.12
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$1.38
Median
$3.02
Typical High
$5.25
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$3.63
Median
$3.63
Typical High
$3.63
United
Setting
Facility
Modifier
Global
Typical Low
$1.26
Median
$2.04
Typical High
$3.02
United
Setting
Professional
Modifier
Global
Typical Low
$1.45
Median
$2.04
Typical High
$3.63