go back

Wisconsin 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
$0.87 / $537.03 / $2,238.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $7,943.28 / $13,182.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,467.37 / $5,623.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $2,238.72 / $4,265.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $4,265.80 / $11,481.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $1,174.90 / $3,630.78
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $6,309.57 / $9,332.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,232.93 / $12,589.25