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Ohio 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 / $1,862.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.20 / $1,195.20 / $1,269.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.27 / $358.26 / $1,675.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$422.70 / $530.83 / $648.79
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 / $1,361.70
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,269.90 / $1,269.90 / $1,269.90
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.90 / $1,269.90 / $1,494.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.27 / $349.52 / $422.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $1,545.05