go back

Washington 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 / $1.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.71 / $0.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.71 / $0.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $33.11 / $64.57
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
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.46
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.65 / $0.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.22 / $0.36