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Virginia 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
$0.27 / $0.27 / $0.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.27 / $0.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $8.51
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.40 / $0.62
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.27 / $0.34 / $0.64
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.60 / $1.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.41 / $0.79
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.41 / $0.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.23 / $0.45