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Arkansas 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
$134.90 / $794.33 / $2,041.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $120.23 / $162.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $302.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $125.89 / $165.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $109.65 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $177.83 / $229.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $346.74 / $776.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $125.89 / $223.87