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South Dakota 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
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$754.50 / $754.50 / $943.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.25 / $506.25 / $632.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $152.10 / $152.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.75 / $69.66 / $69.66
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.00 / $58.00 / $58.00