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Iowa rates for HCPCS A4928

Surgical mask, for dialysis, per 20

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.25 / $1.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $17.00 / $17.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.18 / $9.52 / $12.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $1.25 / $2.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $3.55 / $22.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.32 / $3.55
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.67 / $2.67