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Louisiana 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
$15.20 / $18.73 / $18.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $17.48 / $20.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.06 / $39.40 / $55.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.62 / $15.62 / $19.16
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.95 / $17.95 / $17.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.75 / $17.75 / $17.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.09 / $15.09 / $15.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.77 / $13.33 / $22.03