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Connecticut 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
$1,269.90 / $1,269.90 / $1,986.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,210.14 / $1,269.90 / $1,269.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $1,269.90
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
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.26 / $302.26 / $1,361.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.75 / $1,245.00 / $1,307.25