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Wisconsin rates for HCPCS A6404

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

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

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $2.00 / $7.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.34 / $0.54 / $1.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.89 / $1.05 / $1.70
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.71 / $0.93
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.20 / $0.27 / $0.68
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.38 / $1.23 / $1.70
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.20 / $0.31 / $0.71
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.20 / $0.22 / $5.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $50.12 / $70.79
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.55 / $0.55 / $0.55
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.37 / $0.72 / $1.10
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.68 / $0.68 / $89.13
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $1.20 / $5.50
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.39 / $0.41 / $0.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.14 / $0.20 / $0.35