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Montana rates for HCPCS A6513

Compression Burn Mask Face And/Or Neck Plastic Or Equal Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.74 / $29.74 / $37.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.98 / $872.98 / $872.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.74 / $29.74 / $29.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.98 / $872.98 / $2,250,000.00