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Mouthpiece

South Dakota rates for HCPCS A4617

Mouthpiece

Rates data updated October 2026.

How much does Mouthpiece cost?

$4.17

Typical negotiated rate. In South Dakota, October 2026.

Insurers have agreed to pay about $4.17 for this service. The price depends on where it is billed: about $4.17 from a physician practice, and about $5.01 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$4.17$3.24 to $4.79
FacilityA hospital or hospital-owned outpatient department$5.01$4.07 to $5.01

How much rates vary

Facilitymedian $5 · 10th to 90th $3 to $8Professionalmedian $4 · 10th to 90th $2 to $6
$2$5$10$20$50$100facility $5professional $4

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$3.16
Median
$3.16
Typical High
$3.16
Aetna
Setting
Professional
Modifier
None
Typical Low
$1.38
Median
$2.95
Typical High
$4.07
Cigna
Setting
Facility
Modifier
None
Typical Low
$4.90
Median
$4.90
Typical High
$4.90
Cigna
Setting
Professional
Modifier
None
Typical Low
$4.79
Median
$4.90
Typical High
$6.03
Medica
Setting
Facility
Modifier
None
Typical Low
$3.47
Median
$5.01
Typical High
$8.13
Medica
Setting
Professional
Modifier
None
Typical Low
$1.74
Median
$3.47
Typical High
$44.67
Midlands
Setting
Professional
Modifier
None
Typical Low
$4.79
Median
$4.79
Typical High
$4.90
Midlands
Setting
Professional
Modifier
None
Typical Low
$3.72
Median
$3.72
Typical High
$3.98
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$4.07
Median
$4.37
Typical High
$5.25
United
Setting
Professional
Modifier
None
Typical Low
$1.51
Median
$2.04
Typical High
$3.63
Wellmark
Setting
Professional
Modifier
None
Typical Low
$4.17
Median
$4.17
Typical High
$4.17

Where South Dakota sits

The same service costs 2.6 times more in Hawaii than in California. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Dakota· 9th of 51

$4.17

HI $4.79CA $1.82

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.