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Ohio 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 / $514.00
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
$16.00 / $20.00 / $46.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.80 / $90.80 / $90.80
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.56 / $151.56 / $151.56
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.80 / $90.80 / $90.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $60.00