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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
$143.29 / $2,832.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.57 / $114.47 / $145.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $1,963.00 / $4,852.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.77 / $138.69 / $212.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.86 / $174.21 / $277.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.37 / $173.45 / $755.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.84 / $248.20 / $933.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.00 / $812.80 / $1,351.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.12 / $170.27 / $330.65