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Pennsylvania 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
$768.00 / $3,623.00 / $7,799.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,077.40 / $6,077.40 / $6,077.40
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.00 / $3,839.00 / $8,017.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.43 / $400.08 / $1,496.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,222.00 / $3,475.00 / $6,000.00