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Minnesota 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
$17.02 / $17.02 / $17.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.83 / $17.02 / $22.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $28.97 / $45.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.73 / $26.99 / $28.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.78 / $77.59 / $179.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.54 / $32.70 / $37.15
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.82 / $71.11 / $169.69
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.25 / $29.25 / $30.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.64 / $25.19 / $45.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.69 / $13.15 / $56.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.77 / $13.15 / $26.61