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Michigan rates for HCPCS A6402

Gauze, nonimpregnated, sterile, pad size 16 sq in or less, without adhesive border, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.11 / $0.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.20 / $0.45 / $1.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.18
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.20 / $0.25
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.20 / $0.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.42
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.13
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.12 / $0.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.11 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.08 / $0.13