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Minnesota 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
$0.23 / $0.23 / $0.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.23 / $0.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.61 / $1.00 / $3.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.61 / $0.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.60 / $1.03 / $2.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.80 / $0.95
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.57 / $0.95 / $2.25
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.75 / $0.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.27 / $0.55 / $0.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.22 / $0.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.22 / $0.56