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Missouri 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
$154.88 / $2,570.40 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $125.89 / $239.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,819.70 / $4,168.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $138.04 / $218.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $131.83 / $194.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $162.18 / $257.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $186.21 / $912.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $229.09 / $933.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $691.83 / $1,412.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $154.88 / $263.03