go back

Oklahoma 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
$1,210.14 / $1,210.14 / $1,210.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,210.14 / $1,210.14 / $1,225.08
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 / $1,269.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,210.14 / $1,270.65 / $1,602.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $5,677.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $1,406.85