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Washington 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 / $44.42 / $46.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.57 / $19.57 / $24.91
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.96 / $100.00 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.39 / $75.00 / $189.00
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 / $17.32 / $23.72
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.80 / $0.80 / $1.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.80 / $1.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.14 / $19.14 / $19.14
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.14 / $19.14 / $19.14
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.38 / $3.38 / $189.00