go back

Oklahoma 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
$501.19 / $2,398.83 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $120.23 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $151.36 / $190.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $177.83 / $1,659.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $151.36 / $933.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $616.60 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $120.23 / $177.83