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Wisconsin 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
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $346.74 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $724.44 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $295.12 / $870.96
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $29.51 / $45.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $29.51 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $54.95 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,888.44 / $5,888.44 / $5,888.44
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96