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Wisconsin 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
$177.83 / $1,905.46 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $1,513.56 / $2,630.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $1,949.84 / $7,079.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $5,754.40 / $9,120.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $1,698.24 / $6,606.93
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $2,570.40 / $3,801.89
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $645.65 / $5,248.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $1,445.44 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $3,388.44 / $9,332.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $1,949.84 / $6,025.60
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $5,495.41
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $3,235.94 / $12,589.25
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $10,000.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $10,232.93 / $13,489.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,584.89 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $1,621.81 / $6,918.31