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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
$2,630.27 / $2,754.23 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,230.27 / $1,258.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $416.87 / $1,023.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $426.58 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $1,258.93 / $2,570.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,513.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $2,398.83 / $2,398.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93