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Oregon 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 / $3.60 / $3.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $175.00 / $194.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $43.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.14 / $193.14 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $43.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $2,250,000.00 / $2,400,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $19.50 / $19.50