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Texas 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
Facility
Modifier
Low / Median / High Price
$0.19 / $0.27 / $0.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.26 / $0.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $0.79 / $6,948.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.80 / $0.80
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.67 / $0.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.64 / $90.00 / $90.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.85 / $5.30 / $5.52
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.26 / $0.42 / $0.72
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.31
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.70 / $0.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.27 / $0.42 / $0.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.22 / $0.38
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $8.61