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Washington 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
$380.19 / $4,168.69 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $1,318.26 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $1,949.84 / $5,370.32
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $537.03 / $4,677.35
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $537.03 / $4,677.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $3,467.37 / $3,715.35
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,570.40
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $616.60 / $4,897.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $562.34 / $4,466.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $660.69 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $1,778.28 / $4,677.35
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $302.00 / $2,630.27