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Texas 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
$747.00 / $3,060.00 / $10,639.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,642.82 / $4,739.10 / $9,025.43
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$289.95 / $519.91 / $519.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,376.10 / $2,376.10 / $2,376.10
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $2,667.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.92 / $1,010.14 / $2,256.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.92 / $1,131.58 / $2,951.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,634.00 / $4,345.00 / $10,600.00