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Georgia 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
$2,041.74 / $5,370.32 / $7,413.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $3,311.31 / $6,025.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $1,071.52 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $5,754.40 / $8,511.38