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Minnesota 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
$1,494.00 / $1,494.00 / $1,494.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.20 / $1,240.02 / $1,494.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $225.49 / $3,138.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.39 / $218.73 / $225.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.31 / $818.33 / $1,150.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.58 / $348.04 / $376.71
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.50 / $749.95 / $1,036.53
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.63 / $296.63 / $316.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.27 / $291.27 / $1,602.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $2,855.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $2,256.94