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Tennessee 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
$712.11 / $2,678.00 / $6,681.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,135.70 / $5,135.70 / $5,135.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,917.00 / $3,753.00 / $5,959.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,667.84 / $2,722.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,259.00 / $4,567.00 / $7,669.00