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New Jersey 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
$1,737.80 / $5,495.41 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $123.03 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $162.18 / $389.05
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $158.49 / $239.88
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $776.25 / $1,230.27
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $141.25 / $288.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $2,884.03 / $7,762.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $114.82 / $239.88