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Maine rates for HCPCS 50740

Ureteropyelostomy Anast Ureter Renal Pelvis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.17 / $1,547.17 / $1,646.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,065.14 / $15,647.20 / $17,644.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,483.77 / $1,632.14 / $2,521.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,315.69 / $1,827.84 / $2,618.71
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,371.22 / $1,766.02 / $2,709.17
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.17 / $1,547.17 / $1,646.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,319.72 / $1,705.84 / $2,389.42