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Indiana rates for HCPCS A6258

Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.16 / $5.16 / $6.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.62 / $3.61 / $5.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.67 / $2.67 / $5.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.67 / $2.67 / $3.79
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $5.36 / $8.43
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.47 / $6.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $3.07 / $6.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $3.00 / $4.30