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Oklahoma 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
$1,048.00 / $3,742.00 / $12,600.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,464.88 / $8,620.91 / $13,717.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.79 / $1,571.00 / $5,975.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,157.00 / $3,858.00 / $7,077.94