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Washington rates for HCPCS A6402

Gauze Non-Impregnated Sterile Pad Size 16 Sq. In. Or Less Without Adhesive Border Each Dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.20 / $0.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.09 / $0.21
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.00 / $11.00 / $15.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.14 / $3.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.08
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.69 / $0.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.69 / $0.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.17
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.16
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.14 / $0.25
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.15 / $0.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.13 / $0.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.08 / $0.13
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.13