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Vermont rates for HCPCS 50391

Instillation(s) of therapeutic agent into renal pelvis and/or ureter through established nephrostomy, pyelostomy or ureterostomy tube (eg, anticarcinogenic or antifungal agent)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $134.90 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $158.49 / $281.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $173.78 / $407.38