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Minnesota 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
$91.17 / $119.89 / $2,168.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.17 / $119.89 / $182.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.44 / $395.41 / $878.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.82 / $280.49 / $439.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.89 / $432.39 / $1,040.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.66 / $364.23 / $529.07
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.86 / $395.30 / $819.03
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.32 / $305.49 / $489.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.91 / $200.01 / $630.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.14 / $341.73 / $884.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$586.41 / $1,438.00 / $2,883.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.99 / $322.98 / $494.54