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Indiana 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
$248.17 / $1,049.28 / $11,093.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,614.00 / $9,200.00 / $18,942.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.70 / $365.40 / $1,345.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,218.40 / $2,218.40 / $2,218.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,932.00 / $8,025.00 / $11,038.00