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Arizona 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
$1,170.00 / $2,640.00 / $5,506.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.22 / $123.13 / $515.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.59 / $219.20 / $360.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.18 / $89.66 / $115.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.37 / $92.37 / $92.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.76 / $138.27 / $244.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.34 / $142.37 / $1,126.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.12 / $159.69 / $933.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$704.00 / $1,535.00 / $2,175.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.90 / $134.90 / $241.20