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Minnesota 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 / $123.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $100.00 / $120.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $158.49 / $169.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $107.15 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $54.95 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $19.50 / $20.89
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $52.48 / $61.66
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $16.60 / $22.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $30.90 / $165.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $134.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $181.97