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Montana rates for HCPCS A4928

Surgical mask, per 20

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $1.25 / $1.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $17.00 / $17.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $1.25 / $1.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $1,800,000.00 / $2,400,000.00