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Pennsylvania rates for HCPCS A6025

Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.28 / $10.28 / $14.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.77 / $11.15 / $14.31
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$967.00 / $57,255.43 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.80 / $18.47 / $18.47
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
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.29 / $25.29 / $25.29
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.28 / $10.28 / $14.16
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.77 / $11.15 / $14.16
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.40 / $40.79 / $40.79
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.47 / $13.47 / $13.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.81 / $10.80 / $22.26