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Montana 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
Professional
Modifier
Low / Median / High Price
$0.15 / $0.19 / $0.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.53 / $0.53 / $0.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $0.53 / $0.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.63 / $0.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.53 / $0.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.22 / $0.22