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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
$91.20 / $120.23 / $120.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $125.89 / $234.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $478.63 / $1,096.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $245.47 / $426.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $457.09 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $346.74 / $537.03
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $436.52 / $851.14
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $309.03 / $489.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $199.53 / $1,737.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $269.15 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $1,862.09 / $3,715.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $229.09 / $426.58