CMPRSBURNGARMENT GLOVE-WRIST

Payers reporting HCPCS A6504

Payer pricing summary

Low

Average

$270

Median

$207

High

$1.8k

Payer rate distribution

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#
1	Ambetter facility · percent of total billed charges · outpatientfrom % of charges	1	$423	$423	—	—	6–60	$423 – $423
2	Blue Cross Blue Shield facility · fee schedule · outpatient · +12 other terms	36	$175	$204	$259	127%	—	$0 – $1.6k
3	Aetna fee schedule · outpatient · +9 other terms	29	$108	$143	$115	80%	—	$54 – $578
4	Anthem facility · case rate · outpatient · +5 other terms	15	$33	$36	$8	23%	—	$23 – $56
5	Caresource facility · case rate · outpatient · +1 other terms	15	$34	$36	$8	23%	—	$23 – $57
6	Molina facility · case rate · outpatient · +4 other terms	15	$33	$36	$8	23%	—	$23 – $56
7	UnitedHealthcare facility · case rate · outpatient · +7 other terms	15	$34	$37	$9	23%	—	$23 – $57
8	Wellmark fee schedule · both	13	$58	$58	—	—	—	$58 – $58
9	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$393	$250	$219	87%	—	$0 – $492
10	Optum facility · case rate · outpatient · +1 other terms	11	$31	$34	$8	22%	—	$28 – $51
11	Cigna professional · fee schedule · outpatient · +7 other terms	10	$91	$95	$10	10%	—	$91 – $118
12	Highmark fee schedule · outpatient · +2 other terms	10	$304	$304	—	—	—	$304 – $304
13	Aetna Better Health fee schedule · inpatient · +1 other terms	7	$93	$93	—	—	—	$93 – $93
14	Humana fee schedule · inpatient · +5 other terms	5	$90	$90	—	—	—	$90 – $90
15	First Health professional · fee schedule · both · +3 other terms	3	$99	$99	—	—	—	$99 – $99
16	Bcbs Ks facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	2	$214	$214	$103	48%	—	$92 – $358
17	Excellus fee schedule · outpatient	2	$490	$490	—	—	—	$490 – $490
18	Kaiser facility · fee schedule · inpatient	2	$207	$207	$113	54%	—	$37 – $391
19	Medica facility · percent of total billed charges · inpatientfrom % of charges · +2 other terms	2	$193	$193	$89	46%	—	$103 – $282
20	MultiPlan facility · fee schedule · inpatient · +3 other terms	2	$293	$293	$160	54%	—	$52 – $553
21	Phcs facility · fee schedule · inpatient	2	$293	$293	$160	54%	—	$52 – $553
22	Bcbs Id professional · fee schedule · outpatient	1	$1	$1	—	—	—	$1 – $1
23	Bcbs La facility · fee schedule · outpatient	1	$0	$0	—	—	—	$0 – $0
24	Bcbs Nc facility · fee schedule · outpatient	1	$344	$344	$148	43%	—	$134 – $449
25	Bcbs Nv fee schedule · outpatient	1	$212	$212	—	—	—	$212 – $212

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