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Ohio 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
$613.66 / $4,044.00 / $10,268.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,760.00 / $3,528.00 / $14,996.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.19 / $380.63 / $594.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,840.00 / $5,998.00 / $7,847.00