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Minnesota rates for HCPCS A4928

Surgical mask, for dialysis, per 20

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $1.25 / $1.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.25 / $1.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.53 / $1.00 / $1.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.51 / $0.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.69 / $1.01 / $2.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.47 / $0.56
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.60 / $0.95 / $2.25
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $1.25 / $2.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.96 / $22.96 / $22.96