go back

Massachusetts 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
$1,585.11 / $2,663.12 / $4,410.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,566.00 / $4,801.02 / $4,801.02
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$816.49 / $4,402.00 / $7,608.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.52 / $494.68 / $972.23
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.32 / $493.00 / $6,679.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $4,287.00 / $9,401.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $4,983.00 / $8,810.00