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Montana rates for HCPCS Q2004

Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $100.00 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $31.62 / $95.50
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $25.12 / $25.12
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $25.12 / $25.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $31.62 / $95.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $33.11 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33