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Mouthpiece

Oregon rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $3$50%20%40%10th90th$4Professionalmedian $3 · 10th–90th $1$50%10%10th90th$3$2.0$5.0$10.0$20.0$50.0$100.0$200.0

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
Professional
Modifier
Global
Typical Low
$1.26
Median
$1.91
Typical High
$3.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.82
Typical High
$1.82
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$7.94
Typical High
$9.33
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$2.63
Median
$3.89
Typical High
$7.41
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$3.24
Median
$3.47
Typical High
$4.68
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$3.47
Median
$4.27
Typical High
$4.37
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$4.37
Typical High
$4.37
Providence
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$4.47
Typical High
$7.94
Providence
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$4.07
Typical High
$5.25
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$4.90
Typical High
$4.90
United
Setting
Facility
Modifier
Global
Typical Low
$1.66
Median
$2.04
Typical High
$2.88
United
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$1.82
Typical High
$3.47