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Illinois rates for HCPCS 42104

Exc Lesion Palate Uvula W/O Closure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.61 / $1,207.00 / $5,389.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.04 / $206.33 / $367.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.74 / $2,252.92 / $5,442.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.22 / $231.88 / $359.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.85 / $400.00 / $1,300.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.97 / $236.10 / $410.93
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.03 / $309.81 / $652.09
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.25 / $167.83 / $287.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $325.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$815.00 / $2,685.00 / $5,407.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.89 / $283.88 / $495.57