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North Carolina 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
$23.31 / $23.31 / $23.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.73 / $23.31 / $23.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.37 / $30.44 / $48.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.78 / $21.31 / $22.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.09 / $15.09 / $15.09
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.64 / $25.00 / $41.88
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $23.77 / $45.38
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,211.29 / $2,211.29 / $2,211.29
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.50 / $39.50 / $58.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.81 / $13.90 / $24.76
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.14 / $85.00 / $120.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.35 / $127.35 / $188.93