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Maine 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
Professional
Modifier
Low / Median / High Price
$0.23 / $0.25 / $0.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $7.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.62 / $0.62
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.25 / $0.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.20 / $0.57