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West Virginia 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
$16.09 / $19.57 / $19.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.44 / $24.30 / $37.38
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.25 / $40.25 / $41,999.58
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 / $18.92 / $23.72