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Montana rates for HCPCS 50684

Injection procedure for ureterography or ureteropyelography through ureterostomy or indwelling ureteral catheter

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $117.49 / $275.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $158.49 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $114.82 / $288.40
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $165.96 / $223.87
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $165.96 / $223.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $131.83 / $323.59
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $131.83 / $346.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $123.03 / $239.88