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Pennsylvania 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
$25.41 / $25.41 / $40.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.51 / $31.77 / $40.35
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$967.00 / $57,255.43 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.78 / $47.78 / $47.78
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
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.17 / $64.69 / $69.28
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.93 / $144.93 / $144.93
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.41 / $25.41 / $40.35
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.05 / $31.77 / $43.09
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,042.19 / $2,038.31 / $2,593.29
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.50 / $81.00 / $102.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.82 / $55.82 / $55.82
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $28.69
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.46 / $49.45 / $49.45
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.46 / $48.85 / $49.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.07 / $28.01 / $53.59