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North Dakota 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
$98.58 / $123.84 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.17 / $119.89 / $123.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.68 / $244.95 / $309.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.21 / $232.92 / $381.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.58 / $135.32 / $295.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.29 / $229.39 / $321.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$471.86 / $471.86 / $471.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.29 / $244.32 / $321.58