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Utah rates for HCPCS A6505

Compression Burn Garment Glove To Elbow Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $75.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $75.00 / $75.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.27 / $98.27 / $98.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00