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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
$97.14 / $121.43 / $165.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.14 / $97.14 / $127.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.30 / $172.02 / $266.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.85 / $88.85 / $118.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.82 / $11.82 / $11.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.14 / $118.46 / $734.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.01 / $101.19 / $116.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.58 / $101.19 / $121.43