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Texas 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
$14.12 / $17.48 / $18.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.22 / $17.48 / $23.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $4.50 / $28.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.17 / $31.66 / $76.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $13.49 / $13.49
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.89 / $18.89 / $18.89
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.95 / $17.95 / $17.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.75 / $17.75 / $29.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.09 / $15.09 / $15.09
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.14 / $120.00 / $120.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.45 / $127.35 / $188.93
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.72 / $23.78 / $38.58
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.41 / $23.93 / $25.19
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.81 / $1,271.76 / $1,653.29
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.50 / $39.20 / $52.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.23 / $24.32 / $38.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.09 / $15.09 / $23.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $13.33 / $19.23
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.76 / $25.19 / $34.01