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