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Pennsylvania 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
Facility
Modifier
Low / Median / High Price
$7.48 / $7.48 / $11.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.45 / $9.35 / $14.35
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.62 / $15.25 / $15.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.78 / $10.78 / $21.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.16 / $9.16 / $13.31
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.88 / $15.93 / $21.57
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.48 / $7.48 / $11.87
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.31 / $9.35 / $15.36
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.20 / $21.70 / $30.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.78 / $10.78 / $21.02
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.16 / $9.16 / $20.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.91 / $14.52 / $14.52
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.91 / $14.52 / $17.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.30 / $7.86 / $13.32