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Maine rates for HCPCS L3255

Nonstandard size or length

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $19.05 / $25.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $63.10
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $19.05 / $28.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $52.48