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Ohio 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 $1 · 10th–90th $1–$10%10%20%10th90th$1Professionalmedian $0 · 10th–90th $0–$10%20%10th90th$0$0.2$0.5$1.0$2.0$5.0$10.0$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
Facility
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $2.19 / $2.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.27 / $0.36 / $0.72
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.56 / $0.71 / $0.91
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.66 / $0.78 / $1.32
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.31 / $0.31 / $0.31
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $15.14
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.31 / $0.31 / $0.31
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.47 / $0.63 / $33.11
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.55 / $0.65 / $1.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.37 / $0.37 / $0.37
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.17 / $0.28 / $0.38