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South Carolina 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 / $19.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.40 / $8.00 / $10.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.72 / $23.72 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.32 / $23.72 / $23.72
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.57 / $19.57 / $26.42
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.50 / $23.50 / $23.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00