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Montana 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
$5.43 / $5.43 / $5.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.15 / $81,499.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.16 / $0.16 / $0.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.16 / $0.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.15 / $0.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.11