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Indiana rates for HCPCS L3255

Nonstandard size or length

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $19.50 / $19.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $19.05 / $23.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $363.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $190.55 / $281.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $72.44 / $83.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $23.99 / $23.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $17.38 / $23.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $19.95 / $19.95