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New Hampshire 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
Facility
Modifier
Low / Median / High Price
$11.69 / $11.69 / $14.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.21 / $11.69 / $14.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $4.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.47 / $13.47 / $13.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.54 / $26.54 / $40.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.37 / $11.07 / $22.01