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Louisiana 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
$338.84 / $1,288.25 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $128.82 / $213.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $478.63 / $758.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $162.18 / $204.17
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $229.09 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $147.91 / $204.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $501.19 / $1,202.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $131.83 / $223.87