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Indiana rates for HCPCS A4928

Surgical mask, per 20

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.25 / $1.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.80 / $20.25 / $23.40
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.82 / $17.82 / $17.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $17.00 / $17.00