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Wisconsin 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
$10.25 / $10.25 / $10.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $11.04 / $14.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.66 / $19.43 / $32.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.89 / $16.42 / $21.72
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.70 / $37.79 / $37.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.78 / $46.86 / $72.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.16 / $25.72 / $33.43
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.91 / $15.03 / $20.30
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.28 / $17.66 / $21.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.74 / $18.45 / $80.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.04 / $8.94 / $19.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.17 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.91 / $15.38 / $20.30
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.28 / $17.66 / $21.19
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.66 / $27.16 / $45.17
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.78 / $34.50 / $80.17
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.16 / $10.78 / $89.34
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.66 / $17.66 / $17.66
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.66 / $17.66 / $17.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.96 / $8.81 / $15.14