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Pennsylvania rates for HCPCS 50722

Ureterolysis For Ovarian Vein Syndrome

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $3,839.00 / $8,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.95 / $1,024.17 / $1,315.14
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,480.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.60 / $1,057.03 / $1,057.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$969.50 / $1,323.01 / $2,077.44
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,201.76 / $1,597.63 / $1,597.63
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $4,761.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.95 / $1,090.91 / $2,843.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $1,261.40 / $2,555.80
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.58 / $1,336.07 / $2,192.75
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,001.72 / $1,001.72 / $1,004.53
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$967.26 / $1,004.53 / $1,050.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.00 / $2,391.00 / $6,322.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.33 / $1,263.41 / $2,104.67