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South Carolina 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
$0.26 / $0.26 / $0.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.26 / $0.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.67 / $0.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.26 / $0.36 / $0.95
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.13 / $4.13 / $4.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,000.00 / $3,000.00 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.20 / $0.28