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Massachusetts 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
$0.23 / $0.23 / $0.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.23 / $0.32
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.64 / $1.29 / $90.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.63 / $5.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $1.60 / $1.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.60 / $0.60
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.64 / $0.64 / $0.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.62 / $0.62
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.64 / $90.00 / $90.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.39 / $5.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.30 / $0.66