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New Mexico 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
$0.27 / $0.27 / $0.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.25 / $0.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $1,500.00 / $1,500.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.25 / $0.46 / $0.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.22 / $0.38