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Nebraska 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 / $194.98 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $165.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $12.88 / $12.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $16.60 / $20.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $186.21 / $741.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $102.33 / $120.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $22.91 / $37.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $102.33 / $120.23