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Louisiana rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.00 / $2,562.00 / $4,050.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,059.48 / $1,815.93 / $1,950.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,528.05 / $1,624.04 / $2,108.09
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,129.69 / $1,490.61 / $1,999.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.00 / $1,309.00 / $7,168.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,035.94 / $1,469.79 / $2,432.23