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West 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
$3.32 / $3.32 / $3.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.32 / $3.72 / $4.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.18 / $6.02 / $10.54
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.18 / $4.18 / $13.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.06 / $7.06 / $7.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $3.07 / $29.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.94 / $3.25 / $6.55