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Connecticut 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
$239.88 / $4,570.88 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $131.83 / $269.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $3,162.28 / $11,748.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $213.80 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $199.53 / $331.13
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $204.17 / $251.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $3,890.45 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $158.49 / $323.59