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Massachusetts 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
$1,240.79 / $2,747.00 / $5,454.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$789.00 / $2,854.00 / $7,231.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$304.20 / $304.20 / $590.08
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $1,902.38 / $8,090.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,854.00 / $8,957.60
Mass General Brigham
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$304.20 / $304.20 / $590.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$953.00 / $3,325.00 / $4,662.00