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South Dakota rates for HCPCS L3255

Nonstandard size or length

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $19.05 / $19.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $19.05 / $23.99
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 / $74.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $35.48 / $67.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $77.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $51.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57