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Missouri 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
$1,023.29 / $3,388.44 / $7,943.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,819.70 / $4,168.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $1,318.26 / $4,365.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $3,019.95 / $5,754.40