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Pennsylvania 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
$480.00 / $1,819.00 / $7,175.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,142.60 / $4,142.60 / $4,142.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.97 / $165.72 / $486.51
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.69 / $3,159.00 / $14,886.03
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.24 / $403.76 / $655.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $128.53 / $696.88
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.70 / $617.71 / $642.22
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$852.80 / $1,800.81 / $10,380.70
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$536.00 / $1,978.00 / $7,197.00
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,142.60 / $4,142.60 / $4,142.60
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.22 / $283.36 / $714.24
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $617.40 / $1,197.09
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $128.53 / $696.88
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.72 / $320.04 / $2,772.13
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.72 / $392.94 / $437.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.00 / $1,155.00 / $3,742.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.12 / $464.46 / $769.97