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Louisiana 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
$120.23 / $120.23 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $102.33 / $120.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $114.82 / $114.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $114.82 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $11.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $14.79 / $16.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $112.20