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Michigan 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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.41 / $90.47 / $164.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.50 / $30.00 / $40.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.38 / $37.38 / $37.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.72 / $23.72 / $23.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.47 / $23.72 / $23.72
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.57 / $32.97 / $32.97
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.57 / $31.87 / $37.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.19 / $8.47 / $12.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.90 / $50.90 / $50.90