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South Dakota 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 $129 · 10th–90th $91–$4,3650%20%10th90th$129Professionalmedian $132 · 10th–90th $98–$2750%10%10th90th$132$100.0$200.0$500.0$1.0K$2.0K

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
$91.20 / $120.23 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $120.23 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $275.42 / $363.08
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $199.53 / $316.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $234.42 / $933.25
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $234.42 / $288.40
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $251.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $190.55 / $239.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $204.17 / $331.13
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $229.09 / $295.12