go back

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
$1,445.44 / $3,090.30 / $6,309.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $128.82 / $398.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $177.83 / $263.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $104.71 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $141.25 / $239.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $147.91 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $154.88 / $933.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $1,122.02 / $2,187.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $125.89 / $218.78