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Montana rates for HCPCS A5122

Skin barrier; solid, 8 x 8 or equivalent, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.40 / $51.77 / $51.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.89 / $14.89 / $14.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.78 / $16.01 / $16.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.10 / $16.01 / $16.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.74 / $15.25 / $16.01
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.47 / $12.32 / $17.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.88 / $7.61 / $8.94