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Massachusetts rates for HCPCS 50389

Removal of nephrostomy tube, requiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $2,089.30 / $3,715.35
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $251.19 / $1,174.90
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $1,288.25 / $3,801.89
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $331.13 / $1,230.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $138.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $275.42 / $1,148.15
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $380.19 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $478.63 / $724.44
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,511.89 / $7,079.46
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $407.38 / $1,023.29
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,949.84 / $2,630.27
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $1,348.96 / $3,801.89
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $331.13 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $2,290.87 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $302.00 / $1,047.13