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Utah 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
$177.83 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $125.89 / $281.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $154.88 / $234.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $234.42
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $512.86 / $912.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $213.80 / $269.15
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $186.21 / $316.23
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $177.83 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $128.82 / $218.78