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Mouthpiece

Ohio rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $2$50%10%20%10th90th$4Professionalmedian $3 · 10th–90th $2$50%10%20%10th90th$3$0.1$0.2$1.0$5.0$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
$2.75
Median
$3.63
Typical High
$4.57
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.91
Median
$2.75
Typical High
$4.68
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$2.19
Median
$3.80
Typical High
$6.03
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$2.45
Typical High
$5.25
CareSource
Setting
Facility
Modifier
Global
Typical Low
$2.19
Median
$4.37
Typical High
$5.62
CareSource
Setting
Professional
Modifier
Global
Typical Low
$2.82
Median
$5.37
Typical High
$5.89
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
$4.07
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$6.92
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.82
Typical High
$2.69
Molina
Setting
Professional
Modifier
Global
Typical Low
$1.00
Median
$1.15
Typical High
$1.86
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$4.90
Typical High
$10.23
United
Setting
Facility
Modifier
Global
Typical Low
$1.38
Median
$2.40
Typical High
$4.47
United
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$2.04
Typical High
$3.39