go back

Virginia 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
$305.24 / $4,771.00 / $8,920.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,032.00 / $6,548.00 / $7,221.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$849.51 / $1,224.33 / $1,510.01
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.24 / $1,054.52 / $1,955.40
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.47 / $381.10 / $5,122.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,303.00 / $9,373.00 / $17,192.00