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Montana rates for HCPCS A4223

Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $19.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $18.62 / $18.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $21.88 / $40.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $79.43 / $85.11