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New York 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 / $0.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.25 / $0.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $16.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.67 / $0.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.36
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.35 / $0.35
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.67 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.60 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.26 / $0.56
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.80 / $0.80
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.35 / $0.35