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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
$106.87 / $3,276.00 / $11,576.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.97 / $107.20 / $142.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.29 / $50.08 / $323.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.92 / $147.44 / $229.37
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,438.00 / $2,403.00 / $4,309.00
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.01 / $91.08 / $160.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.40 / $144.90 / $195.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.66 / $1,800.00 / $4,970.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.70 / $149.94 / $247.64
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.04 / $85.42 / $85.42