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South Dakota 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
$0.50 / $0.50 / $0.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $4.23 / $5.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $1.21 / $1.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.20 / $1.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00