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Pennsylvania 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
$8.74 / $8.74 / $13.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $10.93 / $14.25
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$967.00 / $57,255.43 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.82 / $17.82 / $17.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.28 / $7.28 / $7.28
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.72 / $24.14 / $25.85
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.74 / $8.74 / $13.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $10.93 / $16.86
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.10 / $25.40 / $35.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.28 / $7.28 / $7.28
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.74 / $16.97 / $16.97
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.74 / $16.97 / $16.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.56 / $8.89 / $14.82