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Arizona rates for HCPCS A4220

Refill kit for implantable infusion pump

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.60 / $91.19 / $225.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.36 / $38.60 / $91.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $3.60 / $3.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $22.00 / $43.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.17 / $51.17 / $51.17