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Arizona rates for HCPCS 50690

Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,170.00 / $2,640.00 / $7,562.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.30 / $94.79 / $136.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.58 / $244.53 / $402.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.06 / $76.20 / $113.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.90 / $118.90 / $118.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.45 / $112.35 / $209.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.31 / $122.94 / $1,055.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.79 / $153.66 / $3,576.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.00 / $1,535.00 / $2,175.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.04 / $111.52 / $234.38