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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)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $158.49 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $154.88 / $204.17
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $208.93 / $229.09
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $208.93 / $229.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $165.96 / $234.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $138.04 / $239.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $186.21 / $288.40