go back

Indiana 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
$318.07 / $1,259.65 / $11,093.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,614.00 / $9,200.00 / $18,942.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.36 / $468.51 / $1,616.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,218.40 / $2,218.40 / $2,218.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,932.00 / $8,025.00 / $11,038.00