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Virginia 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
$3.72 / $3.72 / $4.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.92 / $3.72 / $4.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.67 / $2.67 / $4.05
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.35 / $3.35 / $3.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.61 / $3.61 / $7.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $3.07 / $3.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.12 / $7.04 / $9.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.72 / $5.00 / $8.91
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.97 / $9.00 / $14.11
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.30 / $5.27 / $9.43
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.30 / $5.27 / $9.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.71 / $3.00 / $4.97