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Montana rates for HCPCS 74420

Urography, retrograde, with or without KUB

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $107.15 / $208.93
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.05 / $30.90 / $107.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $123.03
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$38.02 / $38.02 / $46.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $134.90 / $199.53
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.49 / $27.54 / $63.10
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $134.90 / $204.17
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$38.02 / $38.02 / $46.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $186.21 / $229.09
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$17.78 / $34.67 / $56.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $123.03 / $371.54
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$17.78 / $25.70 / $43.65