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Vermont rates for HCPCS 50120

Pyelotomy W/Exploration

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,274.70 / $1,274.70 / $4,995.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$820.84 / $1,569.22 / $3,352.23
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$990.03 / $1,569.22 / $3,352.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,222.00 / $1,346.62 / $4,114.49