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Alaska rates for HCPCS A6404

Gauze, nonimpregnated, sterile, pad size more than 48 sq in, without adhesive border, each dressing

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.37 / $0.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.40 / $0.83
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.48 / $0.48
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.35 / $3,495.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $1.35 / $1.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.40 / $1.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $1.25 / $2.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $1.20