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Vermont rates for HCPCS Q2004

Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $102.33 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $19.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $102.33 / $104.71