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Mouthpiece

Minnesota rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $12 · 10th–90th $3$350%5%10%10th90th$12Professionalmedian $4 · 10th–90th $2$50%20%40%10th90th$4$1.0$2.0$5.0$10.0$20.0$50.0$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
$2.75
Median
$2.75
Typical High
$2.75
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$2.51
Typical High
$3.72
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.98
Median
$5.13
Typical High
$7.41
BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$4.37
Typical High
$4.37
Cigna
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$15.85
Typical High
$43.65
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.90
Median
$5.25
Typical High
$6.17
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$12.30
Median
$15.85
Typical High
$34.67
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$4.90
Median
$4.90
Typical High
$5.50
Medica
Setting
Facility
Modifier
Global
Typical Low
$2.57
Median
$4.37
Typical High
$8.91
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.23
Median
$1.82
Typical High
$10.47
United
Setting
Facility
Modifier
Global
Typical Low
$1.95
Median
$2.40
Typical High
$3.09
United
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$2.14
Typical High
$5.89