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Texas rates for HCPCS Q2004

Bladder Calculi Irrig Sol

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.14 / $99.57 / $233.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.14 / $99.57 / $103.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.82 / $11.82 / $11.82
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.36 / $734.60 / $734.60
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.37 / $99.57 / $142.38
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.14 / $25.22 / $91.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.65 / $99.57 / $163.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.82 / $13.14 / $91.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.19 / $101.19 / $101.19
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.72 / $98.72 / $133.27