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Utah rates for HCPCS 50391

Instlj Ther Agent Renal Pelvis&/Ureter Via Tub

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.16 / $2,910.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.57 / $165.36 / $222.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.17 / $165.73 / $233.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.59 / $113.33 / $150.06
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.48 / $484.37 / $682.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.22 / $204.80 / $261.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.15 / $149.50 / $255.60