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Iowa 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
$946.33 / $3,751.94 / $7,119.04
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$422.27 / $1,679.21 / $3,207.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$728.53 / $2,722.16 / $8,857.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$816.16 / $2,683.08 / $3,714.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,341.00 / $7,091.00 / $10,320.00