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Tennessee 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
$189.60 / $2,133.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.50 / $102.07 / $152.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $148.00 / $1,676.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.76 / $126.84 / $200.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.56 / $115.01 / $118.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.90 / $122.06 / $211.06
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $736.69 / $1,055.95
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,068.05 / $2,133.71 / $3,694.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $814.00 / $2,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.60 / $149.22 / $314.62