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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
$133.75 / $975.00 / $2,812.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.05 / $133.75 / $162.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.53 / $218.53 / $262.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.36 / $130.18 / $167.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.57 / $110.57 / $110.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.35 / $183.72 / $233.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.00 / $337.00 / $768.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.36 / $133.18 / $235.77