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Montana 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
$14.88 / $14.88 / $14.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $3.61 / $17.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.88 / $8.23 / $91,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.88 / $5.88 / $5.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.32 / $6.32 / $6.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $6.32 / $6.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.51 / $5.73 / $6.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.74 / $4.74 / $7.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.54 / $3.84