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Maine rates for HCPCS 50690

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $104.71 / $169.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $120.23 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $141.25 / $338.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $147.91 / $309.03
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $131.83 / $323.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $128.82 / $257.04