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Mouthpiece

North Carolina rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $3$90%10%10th90th$4Professionalmedian $3 · 10th–90th $2$40%20%40%10th90th$3$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
$3.80
Median
$3.80
Typical High
$3.89
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$3.02
Typical High
$4.37
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$2.19
Median
$2.19
Typical High
$3.09
BCBS
Setting
Facility
Modifier
Global
Typical Low
$4.07
Median
$6.46
Typical High
$8.71
BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$3.31
Typical High
$3.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.82
Typical High
$1.82
Medcost
Setting
Professional
Modifier
Global
Typical Low
$2.34
Median
$2.51
Typical High
$2.95
Medcost
Setting
Facility
Modifier
Global
Typical Low
$2.57
Median
$4.37
Typical High
$8.51
Medcost
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$3.02
Typical High
$7.59
United
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$2.88
Typical High
$4.47
United
Setting
Professional
Modifier
Global
Typical Low
$1.45
Median
$2.09
Typical High
$3.02
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$45.71
Typical High
$45.71