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South Carolina 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
$151.36 / $4,897.79 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $123.03 / $234.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $251.19 / $446.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $125.89 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $81.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $158.49 / $263.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $162.18 / $275.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $1,202.26 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $131.83 / $239.88