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Indiana 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
$1,115.58 / $1,386.00 / $4,846.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,800.00 / $11,044.01 / $15,154.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,151.65 / $1,625.85 / $2,438.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,403.00 / $5,242.00 / $10,843.00