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California rates for HCPCS A6404

Gauze Non-Impregnated Sterile Pad Size More Than 48 Sq. In. Without Adhesive Border Each Dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.67 / $5.56 / $9.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $6.38 / $6.38
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.72 / $1.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $638.07
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.64 / $90.00 / $90.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.85 / $5.30 / $5.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.49 / $0.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.42 / $0.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.22 / $0.68