go back

New Mexico 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
$134.90 / $204.17 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $125.89 / $446.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $151.36 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $169.82 / $223.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $177.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $177.83 / $316.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $169.82 / $223.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $1,096.48 / $1,412.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $169.82 / $251.19