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Georgia rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,173.77 / $5,045.00 / $6,915.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.66 / $1,367.25 / $2,585.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,298.47 / $4,431.64 / $10,456.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,132.30 / $1,596.54 / $3,112.99
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,147.96 / $2,353.67 / $3,614.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$550.00 / $550.00 / $550.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,310.43 / $1,932.32 / $3,193.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,125.19 / $1,462.75 / $3,206.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.00 / $3,629.00 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,191.30 / $1,720.08 / $3,009.59