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West Virginia 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 / $15.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.44 / $24.30 / $130.81
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.87 / $140.87 / $41,999.58
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 / $18.43