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Montana 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 / $1,240.02 / $1,240.02
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
$316.00 / $1,269.90 / $1,269.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.27 / $291.27 / $1,668.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.00 / $1,602.00 / $1,668.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $1,245.00