go back

Utah 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
$1,548.82 / $5,888.44 / $8,511.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $6,025.60 / $13,489.63
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $1,445.44 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64