go back

South Dakota 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
$1,494.00 / $1,494.00 / $1,494.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.90 / $1,494.00 / $1,494.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.50 / $395.50 / $494.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.63 / $302.56 / $370.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.27 / $2,070.39 / $2,524.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $5,677.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$370.70 / $370.70 / $370.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.70 / $1,603.32 / $1,603.32
Sanford Health Plan
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 / $1,692.70
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.00 / $1,335.00 / $1,335.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,335.00 / $1,335.00 / $1,335.00