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Illinois rates for HCPCS A6403

Gauze, nonimpregnated, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing

Facilitymedian $2 · 10th–90th $1–$100%10%20%10th90th$2Professionalmedian $1 · 10th–90th $0–$10%50%10th90th$1$0.2$1.0$5.0$20.0$100.0

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
Facility
Modifier
Typical Low / Median / Typical High
$9.55 / $9.55 / $9.55
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.20 / $1.20 / $1.20
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.62 / $1.35 / $6.46
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.50 / $0.50 / $0.50
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.31 / $0.31 / $0.62
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.48 / $0.66 / $1.38
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.74 / $0.74 / $0.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.28 / $0.46 / $0.58
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.20 / $0.28 / $0.43