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Wisconsin rates for HCPCS A6503

Compression Burn Garment Facial Hood Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.00 / $50.00 / $50.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $50.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.00 / $112.18 / $170.00
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.00 / $50.00 / $75.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.00 / $50.00 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.60 / $139.60 / $139.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.00 / $50.00 / $75.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,900.00 / $5,900.00 / $5,900.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $100.00 / $187.52
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.60 / $139.60 / $139.60