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Massachusetts 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
$102.33 / $102.33 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $102.33 / $114.82
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $81.28 / $147.91
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $102.33 / $107.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $114.82 / $229.09
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $23.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $186.21
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $81.28 / $147.91
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $102.33 / $125.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $30.20 / $102.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $151.36