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New York 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
$122.79 / $2,842.00 / $7,839.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.99 / $144.36 / $238.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,691.00 / $3,333.00 / $4,636.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.47 / $128.72 / $297.45
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.25 / $138.25 / $4,050.00
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.25 / $138.25 / $178.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.21 / $166.21 / $3,479.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.31 / $200.67 / $445.29
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.00 / $149.56 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.90 / $168.82 / $252.65
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.05 / $151.35 / $226.91
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.21 / $555.00 / $3,479.91
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.57 / $205.98 / $444.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.80 / $2,705.00 / $4,840.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.68 / $153.81 / $397.29
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.83 / $125.83 / $355.27
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.76 / $156.07 / $252.93