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Missouri 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
$97.72 / $128.82 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $100.00 / $169.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $173.78 / $269.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $91.20 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $16.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $117.49 / $741.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $102.33 / $117.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $22.91 / $104.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $102.33 / $120.23