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Montana 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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $1,819.70 / $2,041.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $501.19 / $2,089.30