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Oklahoma 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 / $97.72 / $165.96
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $107.15 / $741.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33