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Kentucky 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 / $97.72 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $120.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $117.49 / $120.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $25.12 / $25.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.30 / $12.30 / $18.20
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $12.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33