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Montana rates for HCPCS A4222

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.87 / $28.67 / $146.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.32 / $53.32 / $53.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.48 / $57.48 / $57.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $57.48 / $57.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.33 / $47.78 / $57.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.61 / $40.13 / $57.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.03 / $25.28 / $42.13