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Alabama 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
$575.44 / $1,445.44 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $125.89 / $234.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $616.60 / $831.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $141.25 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $144.54 / $223.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $562.34 / $1,548.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $117.49 / $177.83