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North Carolina 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 / $102.33 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $100.00 / $102.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $107.15
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $102.33 / $117.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $22.91 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $131.83
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31