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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
$112.20 / $141.25 / $331.13
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.05 / $22.91 / $57.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $213.80
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$36.31 / $36.31 / $44.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $165.96 / $323.59
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.50 / $32.36 / $60.26
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $234.42 / $354.81
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$36.31 / $36.31 / $44.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $302.00 / $371.54
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.88 / $36.31 / $52.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $128.82 / $218.78
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.99 / $25.12 / $41.69