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California 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
$1,659.59 / $6,025.60 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $134.90 / $512.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $4,466.84 / $12,882.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $186.21 / $380.19
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $177.83 / $1,778.28
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $181.97 / $354.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $74.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $147.91 / $295.12
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $120.23 / $181.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $131.83 / $229.09
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $602.56
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,047.13 / $1,047.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $177.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $154.88 / $239.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $147.91 / $309.03
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $407.38
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $154.88 / $223.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $1,584.89 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $138.04 / $302.00