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Minnesota 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
$1.00 / $134.25 / $709.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.40 / $130.22 / $134.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.89 / $1,561.14 / $3,618.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$511.31 / $632.80 / $657.92
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$881.71 / $1,430.68 / $3,414.11
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.25 / $506.25 / $603.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $90.00 / $152.10