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South Carolina rates for HCPCS A4211

Supplies For Self-Administered Injections (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $3.00 / $5.29
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,000.00 / $3,000.00 / $3,000.00