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Indiana rates for HCPCS A4221

Supplies for maintenance of noninsulin drug infusion catheter, per week (list drugs separately)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.87 / $22.87 / $25.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.53 / $15.75 / $22.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.80 / $12.80 / $24.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.80 / $12.80 / $18.17
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.19 / $32.75 / $37.79
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.19 / $30.23 / $35.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.09 / $15.09 / $27.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.77 / $14.26 / $22.64