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Ohio 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
$0.20 / $0.20 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.20 / $0.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.59 / $3.18 / $6.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.35 / $0.43
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.67 / $0.67
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.67 / $0.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.20 / $0.28