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Virginia 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
$1,288.25 / $4,786.30 / $15,135.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,918.31 / $11,220.18 / $15,488.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,348.96 / $3,388.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,905.46 / $2,754.23
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,698.24 / $2,511.89
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,584.89 / $5,248.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,467.37 / $7,079.46