go back

Massachusetts 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
$125.89 / $2,238.72 / $3,801.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $125.89 / $407.38
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $575.44 / $2,818.38
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $165.96 / $363.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $109.65 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $199.53 / $416.87
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $177.83 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $147.91 / $218.78
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $2,041.74 / $3,467.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $173.78 / $331.13
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $512.86
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $602.56 / $2,818.38
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $165.96 / $363.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,819.70 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $186.21 / $354.81