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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
$28.84 / $28.84 / $28.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $28.84 / $37.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $346.74 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $288.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $50.12 / $81.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $27.54 / $27.54