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Washington 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
$481.62 / $2,747.39 / $18,711.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,470.05 / $9,286.14 / $18,898.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,353.44 / $2,353.44 / $3,920.80
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$422.92 / $1,647.73 / $3,438.40
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$522.60 / $2,061.59 / $2,339.19
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,470.05 / $1,499.87 / $1,558.32
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,529.68 / $9,873.73 / $18,898.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,297.00 / $12,835.00