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Montana 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
$4,106.88 / $4,106.88 / $4,106.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.53 / $135.13 / $672.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.02 / $82.02 / $642.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.02 / $82.02 / $82.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.02 / $91.96 / $642.53
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.01 / $579.79 / $614.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.98 / $399.35 / $699.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.50 / $472.50 / $472.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.66 / $630.71 / $1,164.57