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Alaska 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
$364.59 / $6,541.00 / $13,413.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.20 / $576.61 / $651.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.55 / $345.55 / $416.16
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.33 / $576.61 / $807.25
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.50 / $609.00 / $856.79
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.50 / $530.70 / $700.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.33 / $576.61 / $807.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.04 / $468.75 / $700.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.89 / $499.38 / $758.86