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Michigan 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
$4.58 / $4.58 / $4.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.71 / $4.58 / $4.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.51 / $18.14 / $34.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.72 / $6.26 / $7.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $3.07 / $8.91
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.34 / $4.34 / $5.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.30 / $4.34 / $7.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.77 / $4.33 / $6.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.13 / $2.83 / $4.30