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Texas 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
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.14 / $8.14 / $8.14
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $90.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.90 / $15.90 / $16.53
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $7.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $7.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.16 / $23.16 / $23.16
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $1.66 / $2.24