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Missouri 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 / $14.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.46 / $65.38 / $65.38
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 / $7.85 / $10.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.05 / $14.62 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.20 / $48.20 / $48.20