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Illinois rates for HCPCS A4257

Replacement lens shield cartridge for use with laser skin piercing device, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.01 / $10.01 / $17.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $10.35 / $15.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.80 / $44.41 / $155.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.84 / $13.37 / $13.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.28 / $7.28 / $10.67
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.16 / $22.64 / $43.20
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
$23.18 / $23.18 / $23.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.25 / $24.96 / $26.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.79 / $8.89 / $15.75