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Wisconsin 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
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.23 / $0.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $1.05 / $1.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.48 / $3.00
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $3.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $4.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.21 / $1.21 / $23.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $3.75
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,900.00 / $5,900.00 / $5,900.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $90.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.38 / $1.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.16 / $23.16 / $23.16