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Indiana rates for HCPCS 50722

Ureterolysis For Ovarian Vein Syndrome

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$951.36 / $1,205.68 / $4,846.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$951.36 / $1,024.17 / $1,341.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,800.00 / $11,044.01 / $15,154.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,032.45 / $1,290.70 / $1,781.16
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$935.00 / $1,191.67 / $1,375.01
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$916.67 / $1,085.72 / $1,375.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$957.99 / $1,285.33 / $2,126.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,403.00 / $5,242.00 / $10,843.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$987.54 / $1,208.89 / $1,962.76