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Virginia 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
$390.88 / $4,390.00 / $8,920.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,032.00 / $6,548.00 / $7,221.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,017.70 / $1,468.91 / $1,811.65
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$390.87 / $1,287.79 / $2,348.21
Medcost
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$903.99 / $2,855.96 / $4,013.07
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.10 / $483.66 / $5,122.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,303.00 / $9,373.00 / $17,192.00