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North Carolina 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
$1,177.08 / $1,615.00 / $7,439.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,177.08 / $1,751.11 / $2,968.80
Medcost
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,696.16 / $2,670.00 / $4,453.20
Medcost
Facility/Professional
Facility
Modifier
80
Low / Median / High Price
$303.14 / $356.00 / $593.76
Medcost
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$192.23 / $249.20 / $415.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,172.00 / $4,086.00 / $7,778.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $8,957.60 / $10,964.16
Wellcare
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$270.76 / $590.08 / $590.08