go back

Mouthpiece

Washington rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $2$80%10%20%10th90th$4Professionalmedian $3 · 10th–90th $1$60%10%10th90th$3$2.0$5.0$10.0$20.0$50.0

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
$2.45
Median
$2.45
Typical High
$5.75
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$2.45
Typical High
$4.07
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$3.09
Typical High
$4.47
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$3.80
Median
$3.80
Typical High
$3.80
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$3.80
Typical High
$4.90
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
$3.09
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$4.57
Typical High
$8.13
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$2.45
Median
$4.47
Typical High
$7.94
Molina
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$4.47
Typical High
$75.86
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
$3.09
Median
$4.37
Typical High
$4.57
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.63
Median
$3.80
Typical High
$7.08
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.63
Median
$3.63
Typical High
$4.17
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$3.80
Typical High
$4.90
United
Setting
Facility
Modifier
Global
Typical Low
$1.70
Median
$2.40
Typical High
$4.47
United
Setting
Professional
Modifier
Global
Typical Low
$1.45
Median
$1.82
Typical High
$3.63
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$3.09
Median
$3.80
Typical High
$6.61