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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
$91.20 / $120.23 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $120.23 / $158.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $239.88 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $229.09 / $331.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $165.96 / $295.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $218.78 / $269.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,041.74 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $181.97 / $269.15