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New York 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
$1,454.63 / $3,996.00 / $10,296.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,283.00 / $5,221.66 / $11,909.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,693.44 / $1,693.44 / $37,499.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,373.51 / $1,373.51 / $7,227.90
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$134.81 / $134.81 / $134.81
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $1,340.00 / $3,169.04
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $1,373.51 / $7,227.90
MVP Health Care
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$134.81 / $134.81 / $134.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,749.00 / $4,194.00 / $9,300.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,553.12 / $1,553.12 / $4,143.10