| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.00 | $20.00 | $20.00 | |
Aetna
| Professional | $20.00 | $20.00 | $20.00 | |
BCBS
| Professional | $4.00 | $4.00 | $4.00 | |
Cigna
| Professional | $3.60 | $3.60 | $3.60 |
Refill Kit For Implantable Infusion Pump (Special Coverage Instructions Apply. See Cim: 60-14)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.00 | $20.00 | $20.00 | |
Aetna
| Professional | $20.00 | $20.00 | $20.00 | |
BCBS
| Professional | $4.00 | $4.00 | $4.00 | |
Cigna
| Professional | $3.60 | $3.60 | $3.60 |