go back

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
$1,407.00 / $4,500.00 / $7,045.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.57 / $166.89 / $284.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.13 / $177.19 / $217.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.57 / $217.90 / $284.74
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.77 / $187.60 / $241.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $196.61
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.81 / $584.88 / $748.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.34 / $182.64 / $234.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $8,244.00 / $9,193.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.12 / $179.34 / $262.70