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Wisconsin rates for HCPCS A5122

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $10.00 / $15.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $18.20 / $29.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $16.60 / $19.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $54.95 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $25.12 / $33.88
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.71 / $15.14 / $25.70
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $28.18 / $36.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $17.78 / $79.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $9.12 / $19.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $26.92 / $47.86
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $35.48 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $19.95 / $89.13
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $7.59 / $11.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $8.71 / $14.45