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Idaho 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
$2,897.00 / $4,500.00 / $7,761.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.80 / $1,113.83 / $3,263.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,810.64 / $8,522.07 / $10,689.08
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$7,904.94 / $12,783.11 / $16,471.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,360.00 / $16,762.00 / $17,870.00