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Vermont rates for HCPCS Q9957

Injection, perflutren lipid microspheres, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $44.67 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $45.71 / $45.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $45.71
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $87.10