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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
$95.54 / $191.75 / $5,449.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.54 / $122.52 / $169.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.00 / $203.44 / $311.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.55 / $185.40 / $308.58
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.54 / $170.35 / $256.94
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.35 / $170.35 / $305.27
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.00 / $213.80 / $317.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.00 / $896.00 / $2,229.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.63 / $166.56 / $360.97
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $468.45 / $468.45
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.00 / $905.84 / $1,037.25