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Washington 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 $257 · 10th–90th $145$7,9430%10%20%10th90th$257Professionalmedian $166 · 10th–90th $100$3160%10%10th90th$166$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$181.97 / $524.81 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $134.90 / $323.59
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $660.69 / $1,348.96
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $208.93 / $295.12
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $223.87 / $346.74
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $218.78 / $323.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $213.80 / $302.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $60.26
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $239.88 / $245.47
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $169.82
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $204.17 / $309.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $691.83 / $1,348.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $204.17 / $295.12
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $870.96 / $1,995.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $181.97 / $316.23
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $141.25 / $181.97