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Missouri 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 / $120.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.66 / $150.00 / $150.00
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 / $104.40 / $217.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.65 / $143.65 / $143.65