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Pennsylvania 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
$831.76 / $2,691.53 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $1,412.54 / $2,754.23
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,570.40 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $676.08 / $3,019.95
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,754.23 / $3,019.95
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $1,949.84 / $2,951.21
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,344.23 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $1,412.54 / $4,073.80
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $4,168.69
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,467.37 / $5,248.07
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $309.03 / $1,778.28
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $309.03 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $676.08 / $4,265.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $1,288.25 / $2,884.03