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Pennsylvania rates for HCPCS A6404

Gauze, nonimpregnated, sterile, pad size more than 48 sq in, without adhesive border, each dressing

Facilitymedian $1 · 10th–90th $0–$57,5440%20%10th90th$1Professionalmedian $0 · 10th–90th $0–$10%20%10th90th$0$0.1$1.0$10.0$100.0$1.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.36 / $0.37 / $0.37
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.71 / $0.71 / $0.71
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.60 / $0.60
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.81 / $0.81 / $0.81
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.60 / $0.60
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.24 / $0.25 / $0.52
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.24 / $0.25 / $0.52
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.18 / $0.23 / $0.48