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Mouthpiece

Wisconsin rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $3$80%50%10th90th$4Professionalmedian $3 · 10th–90th $2$70%10%10th90th$3$0.5$2.0$10.0$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
$2.51
Median
$2.51
Typical High
$2.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$2.63
Typical High
$3.80
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$4.47
Typical High
$7.24
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$4.07
Typical High
$4.68
Cigna
Setting
Facility
Modifier
Global
Typical Low
$11.75
Median
$13.80
Typical High
$21.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$6.03
Typical High
$8.32
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$2.24
Median
$3.55
Typical High
$5.25
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$8.51
Typical High
$10.96
Medica
Setting
Facility
Modifier
Global
Typical Low
$2.24
Median
$3.80
Typical High
$89.13
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$2.14
Typical High
$44.67
Molina
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$6.92
Network Health
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$5.25
Typical High
$8.71
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$2.24
Median
$3.55
Typical High
$5.25
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$2.88
Typical High
$2.88
Quartz
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$6.61
Typical High
$11.22
Quartz
Setting
Facility
Modifier
Global
Typical Low
$8.91
Median
$8.91
Typical High
$89.13
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$19.50
Typical High
$45.71
Security Health
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$4.47
Typical High
$4.47
Security Health
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$4.47
Typical High
$4.47
United
Setting
Facility
Modifier
Global
Typical Low
$1.26
Median
$2.14
Typical High
$4.47
United
Setting
Professional
Modifier
Global
Typical Low
$1.45
Median
$2.14
Typical High
$6.31