go back

North Carolina 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
$257.70 / $1,606.42 / $7,968.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.70 / $1,116.11 / $1,953.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,366.00 / $9,541.00 / $14,589.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,081.44 / $2,081.44