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Oklahoma rates for HCPCS A6404

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.20 / $0.26 / $0.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.22 / $5.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.20 / $0.20 / $0.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.19 / $0.38