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Indiana rates for HCPCS Q2004

Bladder Calculi Irrig Sol

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.14 / $236.93 / $437.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.14 / $97.14 / $97.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.62 / $202.38 / $303.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.50 / $11.60 / $29.45
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.82 / $12.82 / $15.38
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.82 / $14.10 / $14.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.40 / $33.40 / $276.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.19 / $101.19 / $125.48