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Michigan rates for HCPCS Q2004

Bladder Calculi Irrig Sol

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.14 / $97.14 / $303.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.14 / $97.14 / $97.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.32 / $100.32 / $100.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.30 / $100.32 / $100.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.82 / $11.82 / $11.82
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.14 / $126.59 / $270.29
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.14 / $107.26 / $128.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.19 / $101.19 / $107.36