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South Carolina rates for HCPCS 50684

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $4,897.79 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $114.82 / $199.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $72.44 / $158.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $109.65 / $275.42
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $204.17 / $204.17
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $131.83 / $323.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $1,202.26 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $112.20 / $295.12