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Indiana rates for HCPCS L3254

Nonstandard size or width

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.05 / $14.05 / $14.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.05 / $14.05 / $17.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.38 / $65.38 / $126.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.92 / $65.38 / $88.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.24 / $290.69 / $290.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.75 / $10.75 / $10.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $10.75 / $11.07