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Louisiana rates for HCPCS Q2004

Bladder Calculi Irrig Sol

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.43 / $121.43 / $170.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.43 / $121.43 / $121.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.93 / $113.93 / $170.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.93 / $113.93 / $116.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.82 / $11.82 / $11.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.17 / $101.19 / $126.49