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Louisiana 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
$3.45 / $4.25 / $4.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.71 / $4.25 / $4.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.23 / $8.94 / $12.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.11 / $3.73 / $3.73
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $1.15 / $1.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.61 / $3.61 / $3.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $3.07 / $3.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $2.86 / $4.25