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Mouthpiece

Texas rates for HCPCS A4617

Mouthpiece

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $3$100%10%20%10th90th$4Professionalmedian $2 · 10th–90th $2$40%20%10th90th$2$0.1$0.5$5.0$50.0$500.0

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
$2.14
Median
$2.82
Typical High
$3.09
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$2.82
Typical High
$3.80
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$2.19
Median
$3.09
Typical High
$5.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.47
Median
$5.13
Typical High
$12.02
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.04
Median
$2.04
Typical High
$2.04
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$3.16
Typical High
$3.80
Christus
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$4.47
Typical High
$4.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.82
Typical High
$1.82
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$45.71
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$2.45
Median
$4.47
Typical High
$8.32
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$2.69
Median
$4.17
Typical High
$5.75
Molina
Setting
Professional
Modifier
Global
Typical Low
$3.24
Median
$3.24
Typical High
$81.28
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$6.17
Typical High
$9.33
Providence
Setting
Facility
Modifier
Global
Typical Low
$2.45
Median
$4.47
Typical High
$8.32
Providence
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.82
Typical High
$4.07
United
Setting
Facility
Modifier
Global
Typical Low
$1.38
Median
$2.19
Typical High
$4.47
United
Setting
Professional
Modifier
Global
Typical Low
$1.51
Median
$2.00
Typical High
$3.02
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$2.04
Median
$4.47
Typical High
$6.03