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Rhode Island 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
$1,518.41 / $1,543.03 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.05 / $127.27 / $172.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.97 / $154.24 / $203.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.16 / $184.53 / $254.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.22 / $1,183.00 / $4,915.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.12 / $176.23 / $271.61