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Tennessee 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
$269.67 / $2,133.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.54 / $131.16 / $168.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$778.00 / $1,483.00 / $2,244.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.04 / $138.47 / $244.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.42 / $157.78 / $247.49
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $468.45 / $468.45
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.00 / $905.84 / $1,037.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.00 / $808.00 / $2,577.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.99 / $166.35 / $270.91