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Maryland rates for HCPCS A6504

Compression Burn Garment Glove To Wrist Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.00 / $67.00 / $67.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.80 / $90.80 / $90.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.00 / $379.00 / $460.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.53 / $150.00 / $150.00