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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
$380.19 / $3,630.78 / $8,317.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $6,760.83 / $7,413.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $1,258.93 / $1,548.82
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $2,754.23 / $2,754.23
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $1,023.29 / $1,995.26
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $380.19 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $9,549.93 / $19,054.61