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Pennsylvania 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 / $0.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.23 / $0.28
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$967.00 / $57,255.43 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.37 / $0.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.67 / $0.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.21 / $0.21 / $0.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.23 / $0.28
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.80 / $0.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.67 / $0.67
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.22 / $0.45