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Wisconsin rates for HCPCS A6402

Gauze Non-Impregnated Sterile Pad Size 16 Sq. In. Or Less Without Adhesive Border Each Dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.09 / $6.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.17
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.23 / $0.32
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.21 / $0.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $1.05 / $1.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.25 / $0.47
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.13 / $0.15
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.10 / $0.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.13 / $0.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.13 / $0.15
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.10 / $0.15
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.27 / $1.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.52 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.68 / $3.54
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.08 / $0.15