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New Hampshire 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
$16.63 / $16.63 / $19.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.82 / $16.63 / $18.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.12 / $13.76 / $13.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.35 / $29.35 / $29.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.09 / $15.09 / $15.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.20 / $20.20 / $30.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.81 / $13.22 / $20.20
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.77 / $25.49 / $35.76