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Montana rates for HCPCS A6025

Gel Sheet For Dermal Or Epidermal Application (E.G. Silicone Hydrogel Other) Each. (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.51 / $9.27 / $16.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.76 / $25.76 / $25.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.47 / $25.76 / $25.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.27 / $29.73 / $29.73
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $23.78 / $36.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.52 / $10.61 / $10.61