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South 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
$100.00 / $363.08 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $100.00 / $120.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $131.83 / $151.36
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $120.23 / $134.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $112.20