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Wisconsin 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 $0–$10%20%40%10th90th$1Professionalmedian $1 · 10th–90th $0–$10%20%40%10th90th$1$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$0.23 / $0.30 / $0.43
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $2.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.58 / $0.58 / $0.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.54 / $0.54 / $0.62
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.68 / $0.85 / $0.91
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.32 / $1.32 / $1.32
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.82 / $2.09 / $3.39
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.31 / $0.93 / $1.12
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.34 / $0.49 / $0.85
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.55 / $0.89 / $1.12
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.34 / $0.56 / $1.29
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.25 / $0.28 / $3.55
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $50.12 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.95 / $0.95 / $0.95
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.43 / $0.66 / $1.12
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.43 / $0.72 / $1.05
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.15 / $1.15 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.31 / $0.74 / $3.72
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.58 / $0.58 / $0.58
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.58 / $0.58 / $0.58
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.20 / $0.28 / $0.48