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Michigan 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
$67.72 / $535.89 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.27 / $146.94 / $510.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$936.77 / $1,093.49 / $1,489.64
BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$508.23 / $744.82 / $1,010.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.95 / $84.15 / $131.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.51 / $163.06 / $576.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.93 / $643.07 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.11 / $307.55 / $643.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.78 / $407.22 / $586.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$773.00 / $2,580.00 / $4,504.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.65 / $458.79 / $630.49