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Maine 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
Professional
Modifier
Low / Median / High Price
$100.00 / $131.83 / $234.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $154.88 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $165.96 / $229.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $158.49 / $245.47
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $158.49 / $407.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $162.18 / $245.47