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Pennsylvania rates for HCPCS A4928

Surgical mask, 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
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.08 / $2.16 / $2.16
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
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.25 / $1.25
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $17.00 / $17.00