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New Jersey 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
$131.83 / $134.90 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $100.00 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $11.75
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $5,128.61 / $7,079.46
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $25.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $131.83 / $208.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $114.82