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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
$1,965.00 / $3,758.00 / $7,467.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$438.60 / $1,640.88 / $2,700.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,049.52 / $3,049.52 / $3,049.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.64 / $1,104.18 / $4,702.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,878.00 / $4,545.00 / $7,217.00