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Mouthpiece

New York rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $3 · 10th–90th $2$70%10%20%10th90th$3Professionalmedian $3 · 10th–90th $0$70%10%20%10th90th$3$0.1$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$2.63
Typical High
$4.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$2.57
Typical High
$4.07
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$2.19
Median
$3.09
Typical High
$4.47
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.24
Median
$2.14
Typical High
$4.79
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$3.39
Median
$3.63
Typical High
$3.63
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$3.63
Median
$3.63
Typical High
$3.63
Cigna
Setting
Facility
Modifier
Global
Typical Low
$6.76
Median
$6.76
Typical High
$6.76
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.82
Typical High
$1.82
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$7.24
Typical High
$16.98
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$5.25
Typical High
$8.32
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$3.09
Typical High
$3.09
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$50,118.72
Median
$53,703.18
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$4.27
Typical High
$4.37
United
Setting
Facility
Modifier
Global
Typical Low
$1.38
Median
$2.19
Typical High
$12.30
United
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$5.37
Typical High
$10.00
Univera
Setting
Facility
Modifier
Global
Typical Low
$2.88
Median
$2.88
Typical High
$5.01
Univera
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$2.88
Typical High
$3.09