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Arizona rates for HCPCS Q4174

PalinGen or ProMatrX, 0.36 mg per 0.25 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,855.69 / $2,988.00 / $8,653.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.20 / $1,210.14 / $1,269.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.88 / $554.90 / $1,372.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.55 / $293.60 / $693.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,269.90 / $1,269.90 / $1,269.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.90 / $1,269.90 / $1,269.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.27 / $1,331.15 / $2,456.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $2,701.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $1,245.00