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Michigan 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
$158.49 / $2,041.74 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $123.03 / $186.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $144.54 / $218.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $199.53 / $218.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $134.90 / $204.17
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $2,041.74 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $138.04 / $190.55
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $138.04 / $199.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $831.76 / $1,862.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $144.54 / $194.98