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Montana 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
Professional
Modifier
Low / Median / High Price
$219.86 / $921.65 / $10,403.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.83 / $271.83 / $271.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.83 / $271.83 / $2,824.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.57 / $271.83 / $1,707.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.40 / $1,757.87 / $3,090.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,540.34 / $3,149.89 / $5,155.01