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New Hampshire rates for HCPCS A6404

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.25 / $0.25 / $0.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.25 / $0.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $6.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.67 / $0.67
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 / $0.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.23 / $0.62
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.64 / $0.70 / $0.90