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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
$537.03 / $2,884.03 / $18,620.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $3,890.45
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $1,737.80 / $4,466.84
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $2,089.30 / $2,187.76
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $1,548.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $9,772.37 / $19,054.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $12,302.69 / $20,892.96