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Virginia 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
$15.20 / $15.20 / $18.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.05 / $15.84 / $18.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.76 / $13.76 / $20.96
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.66 / $17.66 / $17.66
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.41 / $29.47 / $41.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.20 / $23.77 / $36.43
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.39 / $41.00 / $58.70
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.14 / $24.76 / $42.16
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.14 / $24.76 / $42.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.22 / $13.90 / $23.38