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Michigan rates for HCPCS A4222

Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.56 / $39.56 / $39.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.51 / $35.76 / $39.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.33 / $144.09 / $273.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.39 / $49.69 / $62.11
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.78 / $64.50 / $78.84
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.17 / $62.11 / $110.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $69.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.56 / $47.19 / $54.26
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.56 / $47.19 / $61.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $75.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.78 / $30.12 / $46.73