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Mouthpiece

Utah rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $1 · 10th–90th $1$30%50%90th$1Professionalmedian $2 · 10th–90th $1$190%20%10th90th$2$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
$1.38
Median
$1.38
Typical High
$1.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$2.09
Typical High
$18.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.82
Typical High
$3.55
Molina
Setting
Professional
Modifier
Global
Typical Low
$2.19
Median
$3.16
Typical High
$24.55
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$2.40
Median
$3.09
Typical High
$4.47
Select Health
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$4.47
Typical High
$4.47
Select Health
Setting
Professional
Modifier
Global
Typical Low
$2.19
Median
$4.37
Typical High
$4.47
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$3.72
Median
$4.47
Typical High
$5.37
United
Setting
Facility
Modifier
Global
Typical Low
$1.45
Median
$2.14
Typical High
$2.88
United
Setting
Professional
Modifier
Global
Typical Low
$1.45
Median
$1.82
Typical High
$3.09