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Ohio 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 / $77.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.00 / $4.55 / $7.16
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.67 / $226.67 / $277.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $3.60 / $3.60
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $3.60 / $3.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $50.00