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Wisconsin 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 / $0.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.20 / $0.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.76 / $1.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $1.05 / $1.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.69 / $0.94
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.20 / $0.27 / $0.67
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.20 / $0.27 / $0.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.26 / $5.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.20 / $0.27 / $0.67
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.77 / $1.02
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.63 / $0.67 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $1.70 / $5.30
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.20 / $0.38