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Washington 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
$1,258.93 / $1,258.93 / $1,258.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,230.27 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $50.12 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,258.93
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93