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Tennessee 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
$1,240.02 / $1,240.02 / $2,170.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.20 / $1,240.02 / $1,269.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,369.50 / $1,451.67 / $1,574.93
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,602.00 / $2,988.00 / $5,602.50
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,677.20 / $5,677.20 / $6,723.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.20 / $1,245.00 / $1,245.00