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Nebraska 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
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.75 / $10.75 / $10.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.75 / $10.75 / $10.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.05 / $14.05 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $15.00 / $48.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.97 / $56.21 / $56.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.01 / $49.01 / $56.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $52.94