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California 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
$2,951.21 / $7,585.78 / $18,197.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $4,570.88 / $12,882.50
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $2,754.23 / $7,079.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,454.71
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $1,071.52 / $1,778.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $851.14 / $1,995.26
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $9,332.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $1,000.00 / $1,995.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $10,000.00 / $20,892.96