go back

Maine 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
$1,202.26 / $1,230.27 / $1,479.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,412.54
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $354.81
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,258.93 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $1,258.93 / $1,479.11