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South Carolina 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
$21.34 / $21.34 / $21.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.45 / $21.34 / $23.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.41 / $28.41 / $28.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $28.41 / $35.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.62 / $22.62 / $29.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.09 / $15.09 / $15.09
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.60 / $25.00 / $46.35
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,000.00 / $3,000.00 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.81 / $13.90 / $19.23