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Maine rates for HCPCS 50389

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $173.78 / $588.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $123.03 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $117.49 / $776.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $407.38 / $758.58
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $181.97 / $851.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $302.00 / $758.58