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Texas 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 / $400.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,456.92 / $5,821.21 / $8,577.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.90 / $108.90 / $108.90
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $254.05 / $254.05
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.65 / $143.65 / $143.65
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $90.00 / $255.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $90.00 / $255.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.80 / $90.80 / $90.80
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $150.00 / $202.50