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Utah 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
$24.00 / $24.00 / $24.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.57 / $24.00 / $24.00
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 / $23.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $45.00 / $60.00