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New Jersey 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
$1,030.85 / $1,240.02 / $1,269.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,269.90 / $1,269.90 / $1,643.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.90 / $1,269.90 / $1,269.90
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.26 / $1,361.70 / $1,361.70
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,329.66 / $13,785.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,361.70 / $1,361.70 / $1,361.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $1,346.09