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North Carolina 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
$154.88 / $371.54 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $125.89 / $309.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $186.21 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $177.83 / $295.12
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $147.91 / $239.88
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $229.09 / $316.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $758.58 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $144.54 / $257.04
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $602.56 / $602.56
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,047.13 / $1,047.13