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Pennsylvania rates for HCPCS 50690

Njx Visualization Ileal Conduit&/Ureteropyelog

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.79 / $1,978.00 / $7,629.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.21 / $88.09 / $133.69
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.09 / $119.44 / $179.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.90 / $118.90 / $118.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.62 / $111.60 / $200.15
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.19 / $177.40 / $237.31
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$661.00 / $661.00 / $661.00
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.25 / $85.25 / $85.27
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.00 / $2,070.00 / $7,799.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.34 / $106.44 / $372.16
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.00 / $545.70 / $545.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.77 / $118.90 / $118.90
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.64 / $111.60 / $203.14
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.65 / $115.40 / $580.59
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.65 / $113.37 / $196.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $1,078.00 / $3,742.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.08 / $134.03 / $397.92