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Montana 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
Professional
Modifier
Low / Median / High Price
$8.66 / $15.11 / $76.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.42 / $27.42 / $27.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.56 / $29.56 / $29.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.09 / $29.56 / $29.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.35 / $25.19 / $29.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.88 / $20.88 / $29.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.12 / $13.15 / $15.17