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Colorado 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
$932.00 / $3,133.00 / $8,734.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.01 / $127.77 / $166.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,974.00 / $2,971.00 / $7,022.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.31 / $159.93 / $239.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.42 / $163.06 / $234.82
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.99 / $153.56 / $201.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.51 / $159.90 / $243.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.00 / $1,464.00 / $3,011.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.40 / $198.59 / $330.60