go back

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
$80.73 / $3,374.00 / $9,784.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.28 / $118.62 / $163.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.42 / $174.21 / $352.80
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.90 / $186.71 / $229.62
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.04 / $569.48 / $1,127.66
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.58 / $129.49 / $209.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.00 / $3,339.00 / $9,152.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.08 / $136.30 / $294.33