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Michigan 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
$430.70 / $1,654.75 / $4,933.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,229.39 / $3,106.68 / $4,890.24
BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,930.22 / $2,107.03 / $2,967.43
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$438.46 / $3,379.23 / $4,933.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,296.00 / $7,849.00 / $9,202.00