go back

Iowa rates for HCPCS Q4174

PalinGen or ProMatrX, 0.36 mg per 0.25 cc

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.20 / $1,195.20 / $1,269.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.63 / $370.78 / $1,603.32
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $1,836.00 / $2,252.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,195.20 / $1,494.00 / $2,031.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $2,490.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$370.70 / $370.70 / $1,603.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.70 / $1,603.32 / $1,603.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $1,344.60
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.00 / $1,335.00 / $1,335.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.65 / $1,335.00 / $1,335.00