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Louisiana 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 / $97.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.03
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.38 / $124.38 / $124.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.80 / $90.80 / $90.80