go back

California 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
$1,579.99 / $6,626.00 / $17,538.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$6,229.00 / $6,229.00 / $6,229.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,759.00 / $4,814.00 / $10,536.00
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $5,804.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,091.14 / $2,471.35 / $5,822.29
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.54 / $1,301.93 / $2,174.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.55 / $1,096.61 / $2,367.29
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,667.84 / $2,722.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.96 / $1,272.83 / $2,198.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,509.00 / $9,713.00 / $21,278.00