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New York 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
$516.20 / $3,621.00 / $9,038.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,283.00 / $5,160.00 / $11,809.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.46 / $1,254.00 / $4,050.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.71 / $573.71 / $13,296.25
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $403.00 / $842.09
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,535.22 / $4,535.22 / $11,105.52
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $573.71 / $13,296.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,264.00 / $5,735.00 / $11,176.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.33 / $432.33 / $1,016.47