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Washington 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
$13.88 / $31.51 / $32.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.51 / $13.88 / $24.01
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.69 / $85.00 / $157.46
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.27 / $159.56 / $188.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.47 / $13.47 / $13.47
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.36 / $35.21 / $44.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.50 / $36.25 / $46.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.71 / $6.67 / $50.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.80 / $29.81 / $32.83
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $3.80 / $3.80
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.85 / $34.85 / $35.69
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.33 / $37.79 / $37.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.51 / $10.61 / $17.68
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $4.78