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Illinois rates for HCPCS A6403

Gauze Non-Impregnated Sterile Pad Size More Than 16 Sq. In. Less Than Or Equal To 48 Sq. In. Without Adhesive Border Each Dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.32 / $9.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.34 / $0.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $1.12 / $6.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.46
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.68 / $1.38
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.74 / $0.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.80 / $0.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.21 / $0.28 / $0.53