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Maryland rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,168.67 / $1,217.54 / $6,064.54
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,322.96 / $1,322.96 / $1,512.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.46 / $1,541.03 / $3,567.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.97 / $1,572.02 / $2,513.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,005.76 / $1,475.11 / $2,782.62
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.52 / $1,359.27 / $1,690.76