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Wyoming 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
Professional
Modifier
Low / Median / High Price
$91.20 / $114.82 / $239.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $281.84 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $173.78 / $245.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $295.12 / $3,090.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $223.87 / $398.11