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Michigan 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
$354.81 / $4,073.80 / $9,120.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $389.05 / $389.05
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $4,073.80 / $6,918.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $5,888.44 / $10,000.00