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Nebraska 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
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $48.75 / $59.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $33.00 / $38.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $51.17 / $59.85
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $59.85 / $59.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.35 / $59.85 / $59.85
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.10 / $13.10 / $13.10