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Utah 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
$0.05 / $0.05 / $0.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.09 / $0.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.13 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.11 / $0.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.07 / $0.10