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Illinois rates for HCPCS Q2004

Bladder Calculi Irrig Sol

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.14 / $199.15 / $341.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.14 / $97.14 / $120.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.19 / $508.72 / $1,655.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.82 / $11.82 / $11.82
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.01 / $120.00 / $345.40
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.19 / $101.19 / $107.36