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South Dakota rates for HCPCS A6513

Compression burn mask, face and/or neck, plastic or equal, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.74 / $29.74 / $29.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.74 / $29.74 / $29.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.00 / $347.00 / $433.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.88 / $235.20 / $291.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.26 / $50.26 / $62.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.47 / $36.47 / $36.47
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.45 / $27.45 / $27.45