go back

South Carolina 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
$12.66 / $12.66 / $12.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.46 / $12.66 / $15.74
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.66 / $17.26 / $26.84
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.11 / $10.11 / $10.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.42 / $9.64 / $13.99