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Hawaii rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,230.27 / $1,479.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,412.54 / $1,412.54
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $2,137.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,230.27 / $1,548.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,445.44 / $1,819.70
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $1,174.90 / $1,862.09