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Mouthpiece

South Dakota rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $3$90%20%10th90th$4Professionalmedian $4 · 10th–90th $2$60%10%10th90th$4$2.0$5.0$10.0$20.0$50.0$100.0

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
$3.16
Median
$3.16
Typical High
$3.16
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$2.95
Typical High
$3.63
Cigna
Setting
Facility
Modifier
Global
Typical Low
$4.90
Median
$4.90
Typical High
$4.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.90
Median
$4.90
Typical High
$6.03
Medica
Setting
Facility
Modifier
Global
Typical Low
$2.95
Median
$4.37
Typical High
$9.12
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.74
Median
$2.14
Typical High
$6.03
Midlands
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$4.79
Typical High
$4.79
Midlands
Setting
Facility
Modifier
Global
Typical Low
$4.90
Median
$4.90
Typical High
$4.90
Midlands
Setting
Professional
Modifier
Global
Typical Low
$3.72
Median
$3.98
Typical High
$3.98
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$3.63
Median
$4.37
Typical High
$5.75
United
Setting
Facility
Modifier
Global
Typical Low
$2.04
Median
$2.14
Typical High
$3.09
United
Setting
Professional
Modifier
Global
Typical Low
$1.51
Median
$2.34
Typical High
$4.37
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$4.17
Median
$4.17
Typical High
$4.17