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Nebraska 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
$257.04 / $3,801.89 / $12,589.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $125.89 / $512.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,951.21 / $5,754.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $162.18 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $218.78 / $363.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $199.53 / $1,230.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $251.19 / $933.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $288.40 / $363.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $275.42
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $234.42 / $316.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $1,230.27 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $208.93 / $295.12