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Washington 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
$3.41 / $7.74 / $8.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.84 / $3.41 / $8.08
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.27 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.27 / $44.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $3.07 / $3.07
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.66 / $7.73 / $12.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.66 / $7.74 / $11.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.15 / $5.08 / $5.08
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.78 / $5.88 / $6.62
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $6.02 / $6.02
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.00 / $5.27 / $9.75
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.88 / $6.76
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $5.12 / $6.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.43 / $3.07 / $4.87
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.67 / $2.67 / $5.12