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North Carolina 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
$1,269.90 / $1,269.90 / $1,269.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,225.08 / $1,269.90 / $1,269.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.60 / $60.00 / $3,000.00
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
$1,269.90 / $1,269.90 / $1,494.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,269.90 / $1,521.90 / $1,643.40
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,521.90 / $1,521.90 / $1,521.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $1,618.50
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,602.00 / $2,241.00 / $2,988.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,677.20 / $5,677.20 / $6,723.00