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South Carolina 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
Professional
Modifier
Low / Median / High Price
$130.00 / $144.16 / $228.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.38 / $124.38 / $151.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.80 / $90.80 / $90.80
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $103.50 / $190.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00