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Mouthpiece

South Carolina rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $2$90%10%10th90th$4Professionalmedian $3 · 10th–90th $1$40%10%20%10th90th$3$0.2$0.5$1.0$2.0$5.0$10.0$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
$3.47
Median
$3.47
Typical High
$3.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$2.95
Typical High
$3.80
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$3.09
Typical High
$3.09
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.98
Median
$4.47
Typical High
$8.91
BCBS
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$4.68
Typical High
$5.62
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
Medcost
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.95
Medcost
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$3.98
Typical High
$9.33
Medcost
Setting
Professional
Modifier
Global
Typical Low
$1.38
Median
$1.38
Typical High
$1.45
United
Setting
Facility
Modifier
Global
Typical Low
$1.26
Median
$2.14
Typical High
$4.47
United
Setting
Professional
Modifier
Global
Typical Low
$1.51
Median
$2.04
Typical High
$3.24