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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)

Facilitymedian $2,692 · 10th–90th $589–$8,3180%5%10%10th90th$2,692Professionalmedian $123 · 10th–90th $91–$2690%20%10th90th$123$50.0$200.0$1.0K$5.0K$20.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $2,691.53 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $123.03 / $338.84
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,258.93 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $154.88 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $141.25 / $223.87
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $213.80
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $165.96 / $239.88
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $1,995.26 / $7,244.36
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $120.23 / $275.42
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $190.55 / $263.03
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$27.54 / $117.49 / $794.33
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $95.50 / $147.91
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $676.08 / $3,890.45
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $128.82 / $218.78