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Utah rates for HCPCS A6404

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

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.91 / $30.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.36
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.65 / $0.78
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.32 / $0.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.22 / $0.33