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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)

Facilitymedian $813 · 10th–90th $112$7,0790%5%10%10th90th$813Professionalmedian $135 · 10th–90th $98$2340%10%10th90th$135$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $2,630.27 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $125.89 / $218.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,570.40 / $2,951.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $141.25 / $213.80
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $323.59 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $147.91 / $245.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $147.91 / $389.05
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $229.09 / $295.12
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $154.88 / $245.47
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $134.90 / $1,659.59
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $169.82 / $1,659.59
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $1,047.13 / $2,344.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $147.91 / $229.09