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Utah rates for HCPCS 52005

Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $3,235.94 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $295.12 / $691.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $288.40 / $512.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $630.96
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $3,467.37 / $7,943.28
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $302.00 / $562.34
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $295.12 / $758.58
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $380.19 / $549.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $263.03 / $489.78