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Georgia 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
$1,202.00 / $5,063.00 / $6,915.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,206.01 / $3,514.57 / $6,339.18
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$622.91 / $687.14 / $1,055.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,090.96 / $2,090.96 / $2,090.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.27 / $1,369.26 / $5,479.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,519.00 / $6,351.00 / $8,836.00