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Mississippi 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
$114.82 / $954.99 / $1,995.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $125.89 / $263.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $63.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $51.29 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $165.96 / $245.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $562.34 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $141.25 / $269.15