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Washington rates for HCPCS A6404

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

Facilitymedian $1 · 10th–90th $0–$10%20%10th90th$1Professionalmedian $1 · 10th–90th $0–$10%10%10th90th$1$0.2$1.0$5.0$20.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.05 / $1.05 / $1.05
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.60 / $0.60
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.43 / $0.71 / $0.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.43 / $0.71 / $0.85
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.70 / $33.11 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.62 / $0.68 / $0.76
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.76 / $0.76 / $0.76
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.45 / $0.45 / $0.46
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.46 / $0.62 / $0.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.17 / $0.17 / $0.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.20 / $0.22 / $0.36