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Utah 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
$1,905.46 / $4,570.88 / $8,511.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $6,025.60 / $13,489.63
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$7,585.78 / $8,912.51 / $20,417.38
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $1,737.80 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64