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Illinois rates for HCPCS A6404

Gauze Non-Impregnated Sterile Pad Size More Than 48 Sq. In. Without Adhesive Border Each Dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.21 / $0.21 / $0.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.21 / $0.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $113.20 / $401.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $1.10 / $150.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.00 / $2,500.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.22 / $0.37