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Wisconsin rates for HCPCS 50693

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; pre-existing nephrostomy tract

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $1,047.13 / $6,456.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,897.79 / $7,585.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $3,090.30 / $5,011.87
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $1,905.46 / $3,801.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $4,265.80 / $11,481.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $1,047.13 / $3,235.94
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $6,309.57 / $9,332.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,232.93 / $12,589.25