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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
$111.51 / $3,226.00 / $8,294.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.93 / $117.03 / $139.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,735.00 / $2,390.00 / $2,954.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $127.66 / $188.42
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.37 / $162.66 / $974.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.77 / $155.52 / $269.33
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.48 / $142.18 / $175.35
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.51 / $150.94 / $225.60
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.00 / $176.66 / $235.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.77 / $135.10 / $805.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.33 / $168.23 / $805.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $1,045.00 / $2,364.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.55 / $181.25 / $273.20