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Indiana 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
$0.28 / $0.28 / $0.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.21 / $0.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.38 / $6.38 / $12.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.59 / $6.38 / $8.80
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.27 / $0.39 / $2.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.36 / $2.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $8.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.20 / $0.35