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Maryland 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
$3,775.68 / $3,775.68 / $3,775.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,745.52 / $1,745.52 / $1,745.52
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,112.65 / $1,456.30 / $2,598.30