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Indiana rates for HCPCS L3255

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.57 / $19.57 / $19.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.57 / $19.57 / $24.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.00 / $189.00 / $364.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.14 / $189.00 / $249.48
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.50 / $83.05 / $83.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.72 / $23.72 / $23.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.32 / $23.72 / $24.43