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Utah 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
$8.66 / $8.66 / $8.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.66 / $15.45 / $76.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.09 / $15.09 / $15.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.87 / $22.64 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.30 / $17.63 / $17.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.15 / $19.23