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Montana 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)

Facilitymedian $204 · 10th–90th $166–$2400%20%10th90th$204Professionalmedian $166 · 10th–90th $102–$3980%10%10th90th$166$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $158.49 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $151.36
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $154.88 / $194.98
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $208.93 / $229.09
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $208.93 / $229.09
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $165.96 / $239.88
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $151.36 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $165.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $190.55 / $302.00