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Pennsylvania 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
$1,195.20 / $1,269.90 / $1,269.90
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.97 / $771.90 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.90 / $771.90 / $771.90
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
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.26 / $1,157.45 / $1,361.70
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,269.90 / $1,269.90 / $1,269.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.20 / $1,269.90 / $1,269.90
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,269.90 / $1,269.90 / $1,269.90
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.90 / $1,269.90 / $1,269.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $1,556.25