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Florida 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
$549.54 / $3,235.94 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $120.23 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $50.12 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $151.36 / $275.42
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $2,511.89 / $4,365.16
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $95.50 / $144.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $147.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $1,584.89 / $3,890.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $134.90 / $234.42
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $85.11 / $128.82