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Wisconsin 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
$0.23 / $0.34 / $0.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.34 / $0.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $0.56 / $0.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.86 / $1.22
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.68 / $1.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.80 / $2.11 / $2.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.94 / $1.09
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.48 / $0.56
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.48 / $0.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.34 / $0.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.48 / $0.56
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.56
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.79 / $1.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.15 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $2.52 / $3.54
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.25 / $0.28 / $0.55