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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
$1,513.56 / $1,548.82 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $125.89 / $309.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $114.82 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $181.97 / $263.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $1,412.54 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $154.88 / $223.87