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South 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
$741.31 / $8,709.64 / $16,595.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $4,365.16 / $8,709.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,691.53
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $977.24 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $13,182.57 / $23,442.29