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Nebraska 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
$2,137.96 / $7,244.36 / $13,489.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $12,589.25 / $24,547.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $1,584.89 / $5,754.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $2,344.23 / $3,235.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $5,495.41 / $8,912.51