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Maine rates for HCPCS A6402

Gauze, nonimpregnated, sterile, pad size 16 sq in or less, without adhesive border, each dressing

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.08 / $0.15