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Illinois rates for HCPCS L4210

Repair Of Orthotic Device Repair Or Replace Minor Parts (Special Coverage Instructions Apply. See Mcm: 2133 2100.4 2130d)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $210.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $25.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.50 / $255.55 / $1,806.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.38 / $117.89 / $117.89
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.93 / $81.25 / $162.43
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.77 / $28.77 / $28.77