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Wisconsin rates for HCPCS L3254

Non-Standard Size Or Width (Special Coverage Instructions Apply. See Mcm: 2323)

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 / $14.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.57 / $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 / $10.75 / $11.07
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.05 / $14.05 / $25.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.05 / $14.14 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.90 / $50.90 / $50.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.30 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.05 / $14.05 / $25.29
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.75 / $65.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $10.75 / $10.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.90 / $50.90 / $50.90