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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
$1,318.26 / $2,344.23 / $4,897.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $14,125.38 / $19,054.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,202.26 / $1,348.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,905.46 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $5,754.40 / $12,022.64