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Utah 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
$16.98 / $16.98 / $16.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $33.11 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $34.67 / $47.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $34.67 / $38.90
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $47.86 / $51.29
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $48.98 / $58.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $25.12 / $39.81