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Missouri 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
$1,389.39 / $4,470.00 / $12,154.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,224.00 / $4,449.00 / $10,043.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$989.60 / $1,904.16 / $7,903.00
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$304.20 / $550.73 / $550.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,185.00 / $3,233.00 / $11,343.00