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Louisiana rates for HCPCS A6404

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.22 / $0.27 / $0.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.27 / $0.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.24 / $0.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.70 / $0.70 / $0.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.19 / $0.35