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Montana rates for HCPCS 74400

Urography (pyelography), intravenous, with or without KUB, with or without tomography

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.56 / $130.47 / $396.16
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.39 / $22.81 / $80.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.28 / $36.28 / $212.95
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$36.28 / $36.28 / $44.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.80 / $166.11 / $275.68
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.73 / $36.28 / $56.81
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$36.28 / $36.28 / $44.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.61 / $212.95 / $343.58
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.47 / $36.28 / $48.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.93 / $129.91 / $228.16
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.90 / $25.07 / $43.73