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Massachusetts rates for HCPCS A4221

Supplies For Maintenance Of Non-Insulin Drug Infusion Catheter Per Week (List Drug Separately)(Desc Revised 1/1/2017)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.82 / $13.82 / $13.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.22 / $15.45 / $18.43
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.46 / $39.61 / $120.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.22 / $24.46 / $127.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.59 / $21.59 / $64.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.09 / $16.09 / $21.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.09 / $15.09 / $21.63
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.88 / $18.88 / $18.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.20 / $20.20 / $20.20
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.14 / $120.00 / $120.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.23 / $18.11 / $127.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.23 / $18.11 / $35.63