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Nebraska 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
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.48 / $17.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.88 / $2.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.96 / $22.96 / $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 / $0.32