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Pennsylvania 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
$13.05 / $13.05 / $20.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.00 / $16.32 / $21.99
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$967.00 / $57,255.43 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.19 / $25.19 / $25.19
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
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.45 / $34.11 / $36.53
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.66 / $95.66 / $95.66
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.05 / $13.05 / $20.73
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.00 / $16.32 / $31.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$819.61 / $1,345.77 / $1,693.06
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.60 / $39.20 / $52.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.35 / $29.35 / $29.35
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.09 / $15.09 / $15.09
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.06 / $25.41 / $25.41
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.06 / $25.41 / $25.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.11 / $14.32 / $25.96