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West Virginia rates for HCPCS 50695

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, with separate nephrostomy catheter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.48 / $1,216.94 / $1,700.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$357.79 / $396.10 / $431.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.71 / $573.71 / $573.71