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Arizona rates for HCPCS 50694

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, without separate nephrostomy catheter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $3,890.45 / $7,762.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $1,318.26 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,019.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $1,122.02 / $5,754.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $4,073.80 / $7,244.36