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Minnesota rates for HCPCS A4220

Refill Kit For Implantable Infusion Pump (Special Coverage Instructions Apply. See Cim: 60-14)

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
$1.00 / $38.64 / $192.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.88 / $32.59 / $33.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.17 / $107.59 / $249.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.39 / $45.34 / $49.53
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.77 / $98.60 / $235.30
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $39.00 / $41.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $54.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.85 / $59.85 / $59.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.61 / $43.18 / $45.36