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New Hampshire 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
$102.33 / $102.33 / $123.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $102.33 / $102.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $213.80 / $371.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $11.75
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $173.78 / $194.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $158.49