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Arizona rates for HCPCS A6504

Compression burn garment, glove to wrist, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.86 / $110.72 / $273.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.93 / $156.22 / $369.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.80 / $90.80 / $90.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $99.00 / $190.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $90.00 / $143.65