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Indiana 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
$109.65 / $1,380.38 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $123.03 / $234.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $4,466.84 / $8,709.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $123.03 / $190.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $97.72 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $141.25 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $144.54 / $269.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $2,137.96 / $5,754.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $131.83 / $208.93