go back

Utah 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
$70.00 / $2,164.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.71 / $113.60 / $288.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.39 / $111.73 / $232.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.71 / $114.12 / $148.82
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.61 / $166.23 / $217.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.51 / $150.96 / $247.81