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Georgia rates for HCPCS 50715

Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,228.71 / $4,733.00 / $6,915.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,341.88 / $4,390.45 / $10,456.09
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,273.91 / $2,486.34 / $3,818.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$550.00 / $550.00 / $550.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,191.17 / $1,548.52 / $3,229.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$78.20 / $78.20 / $78.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$39.11 / $39.11 / $39.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.00 / $3,629.00 / $10,000.00