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Montana rates for HCPCS A6455

Self-adherent bandage, elastic, nonknitted/nonwoven, width greater than or equal to 5 in, per yd

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.45 / $37.45 / $37.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $1.17 / $5.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.66 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $2.04 / $2.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.46 / $1.85 / $2.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.53 / $1.53 / $2.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.83 / $0.97