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Oregon 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 / $1.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.58 / $0.72 / $151.36
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.23 / $0.40 / $0.74
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.71 / $0.71
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.66 / $0.76
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.22 / $0.43 / $0.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $79.43
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $0.71 / $0.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.22 / $0.34