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West 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
$0.19 / $0.19 / $0.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.20 / $0.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.27 / $0.39 / $0.51
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.67 / $0.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $1.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.33 / $0.46