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Alaska rates for HCPCS 50695

Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, with separate nephrostomy catheter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,607.12 / $10,175.36 / $13,413.92
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.58 / $2,272.37 / $7,986.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.58 / $2,272.37 / $7,986.50