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Indiana 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 / $234.42 / $436.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $102.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $151.36 / $234.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $15.49 / $74.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.30 / $21.88 / $22.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $13.18 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $22.91 / $22.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $120.23