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Idaho 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
$1,412.54 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $158.49 / $281.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $323.59 / $741.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $199.53 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $173.78 / $218.78
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $141.25 / $316.23
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $169.82 / $257.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $549.54 / $776.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $169.82 / $204.17
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $186.21 / $436.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $8,317.64 / $9,332.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $158.49 / $229.09