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Michigan 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
$1,195.20 / $1,195.20 / $1,195.20
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
$329.25 / $1,269.90 / $1,361.70
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,195.20 / $1,319.70 / $1,602.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.20 / $1,319.70 / $1,583.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $1,320.95