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Virginia 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
$12.88 / $14.13 / $14.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $12.02 / $15.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $10.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $23.99 / $23.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $13.49 / $13.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $19.50 / $30.90
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $15.85 / $31.62
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $13.80 / $16.98
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $20.42 / $81.28
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $20.42 / $81.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.55 / $12.59 / $22.91