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Florida rates for HCPCS Q2004

Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $100.00 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $100.00 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $549.54
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $16.98 / $22.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $107.15
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $97.72