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Washington, DC 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
$134.90 / $2,754.23 / $4,073.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $131.83 / $323.59
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $338.84 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $147.91 / $354.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $141.25 / $281.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $549.54 / $1,548.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $141.25 / $275.42