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Virginia 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
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.20 / $1,195.20 / $1,595.35
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,361.70 / $1,361.70 / $1,361.70
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,153.20 / $1,297.34 / $1,297.34
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,269.90 / $1,494.00 / $1,934.06
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,419.30 / $1,494.00 / $1,494.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,245.00 / $1,419.30 / $1,867.50
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,419.30 / $1,867.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.00 / $1,245.00 / $1,441.50