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California 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
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.92 / $3.48 / $5.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.00 / $4.00 / $4.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.79 / $3.91 / $6.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $3.60 / $3.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $50.00 / $638.07
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $90.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.17 / $51.17 / $51.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $44.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $3.60 / $3.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $19.50 / $19.50