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Utah rates for HCPCS 50722

Ureterolysis for ovarian vein syndrome

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,071.52 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,380.38 / $2,089.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,819.70
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,949.84 / $2,398.83
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,862.09 / $2,187.76
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,621.81 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,202.26 / $2,137.96