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Tennessee 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
$2,398.83 / $2,691.53 / $7,585.78
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$6,165.95 / $6,165.95 / $6,165.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,454.71 / $4,570.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $10,964.78 / $10,964.78
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,630.27 / $4,786.30