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New Hampshire 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
$34.31 / $34.31 / $41.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.53 / $34.31 / $36.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.10 / $26.10 / $27.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.82 / $55.82 / $55.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $28.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.31 / $38.31 / $58.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.14 / $25.73 / $38.31
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.36 / $50.76 / $71.20