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Maine rates for HCPCS A5122

Skin Barrier; Solid 8 X 8 Or Equivalent Each (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.67 / $8.75 / $8.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.97 / $7.97 / $7.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.76 / $10.78 / $12.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.66 / $9.16 / $12.32
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.44 / $12.44 / $12.44
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.02 / $8.75 / $11.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.07 / $8.21 / $17.50