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Virginia 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
$112.20 / $2,630.27 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $125.89 / $186.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,570.40 / $2,951.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $141.25 / $213.80
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $165.96 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $147.91 / $251.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $154.88 / $389.05
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $229.09 / $295.12
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $154.88 / $245.47
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $131.83 / $1,659.59
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $169.82 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $1,202.26 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $144.54 / $229.09