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Kansas 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
$229.09 / $3,630.78 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $125.89 / $234.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $147.91 / $239.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $169.82 / $1,096.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $165.96 / $933.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $416.87 / $1,778.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $138.04 / $194.98