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Wisconsin 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 $2,818 · 10th–90th $324$5,7540%10%10th90th$2,818Professionalmedian $158 · 10th–90th $98$4570%10%10th90th$158$50.0$200.0$1.0K$5.0K

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
$97.72 / $199.53 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $125.89 / $257.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $3,090.30 / $5,754.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $234.42 / $562.34
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $380.19 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $275.42 / $407.38
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $1,698.24 / $3,801.89
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $269.15 / $363.08
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $616.60 / $1,778.28
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $239.88 / $891.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $165.96
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $891.25 / $2,344.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $316.23 / $436.52
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $281.84 / $436.52
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $602.56 / $602.56
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $316.23 / $912.01
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $645.65
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $645.65 / $812.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $1,584.89 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $190.55 / $489.78