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Missouri 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
$135.02 / $2,507.00 / $8,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.70 / $109.32 / $372.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$862.00 / $1,818.00 / $4,958.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.50 / $106.34 / $180.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.90 / $118.90 / $118.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.58 / $124.44 / $239.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.70 / $136.19 / $550.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.52 / $189.88 / $3,576.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.00 / $875.00 / $1,351.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.52 / $141.01 / $255.83