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Ohio 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
$138.04 / $2,570.40 / $10,715.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $123.03 / $346.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $2,137.96 / $3,981.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $128.82 / $223.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $97.72 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $158.49 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $151.36 / $251.19
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $151.36 / $251.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $309.03
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $134.90 / $257.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $912.01 / $2,951.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $134.90 / $213.80