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South 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
$1,230.27 / $1,230.27 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,230.27 / $1,258.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $245.47 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,380.38 / $2,089.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $87.10 / $1,348.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,258.93 / $1,258.93