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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
$467.74 / $2,137.96 / $4,073.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $125.89 / $223.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,513.56 / $2,137.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $158.49 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $151.36 / $239.88
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $602.56 / $602.56
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,047.13 / $1,047.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $812.83 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $154.88 / $245.47