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Tennessee 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
$707.95 / $2,398.83 / $6,456.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $4,073.80 / $5,888.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $2,187.76
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $9,332.54 / $9,332.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $4,570.88 / $7,585.78