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Minnesota 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
$320.70 / $1,363.37 / $4,828.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,559.11 / $7,388.25 / $12,389.06
BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$7,949.16 / $12,060.61 / $21,147.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,347.16 / $4,746.68 / $11,418.79
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,721.00 / $4,339.60 / $8,991.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.61 / $2,156.15 / $6,927.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,293.00 / $6,652.00 / $9,810.00