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Missouri rates for HCPCS 50705

Ureteral embolization or occlusion, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $2,832.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.88 / $1,697.33 / $2,110.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $1,963.00 / $4,852.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.64 / $826.98 / $2,825.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.97 / $1,452.80 / $4,202.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.21 / $875.00 / $3,217.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,967.59 / $3,376.40 / $13,214.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.00 / $760.00 / $1,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,950.64 / $2,616.94 / $5,258.06