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Pennsylvania 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
$724.44 / $2,691.53 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $123.03 / $338.84
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,258.93 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $154.88 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $144.54 / $239.88
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $194.98 / $213.80
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $165.96 / $239.88
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $2,344.23 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $144.54 / $398.11
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $144.54 / $251.19
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $218.78 / $263.03
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $117.49 / $794.33
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $97.72 / $309.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $676.08 / $3,890.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $131.83 / $218.78