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Pennsylvania 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 / $182.51 / $185.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$967.00 / $57,255.43 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.38 / $58.51 / $58.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $3.60 / $3.60
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.64 / $16.64 / $181.37
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $182.51 / $185.72
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $23.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $13.10 / $13.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $3.60 / $3.60