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Nationwide 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
Facility
Modifier
Low / Median / High Price
$173.78 / $2,818.38 / $8,912.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $125.89 / $263.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $3,715.35 / $9,549.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $151.36 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $251.19 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $169.82 / $363.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $1,071.52 / $3,467.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $141.25 / $257.04