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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
$134.13 / $169.27 / $651.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.16 / $161.31 / $446.08
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.10 / $200.86 / $446.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.80 / $177.75 / $547.52