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Pennsylvania 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
$1,047.13 / $4,786.30 / $8,317.64
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $7,585.78 / $57,543.99
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,488.17 / $15,488.17 / $15,488.17
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $3,801.89 / $8,317.64
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $323.59 / $2,454.71
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $316.23 / $1,230.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $3,981.07 / $10,964.78