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Maine rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,478.12 / $1,478.12 / $1,666.30
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
$1,388.28 / $1,536.00 / $2,348.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,366.52 / $1,719.21 / $2,463.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,277.16 / $1,644.88 / $2,523.34
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,478.12 / $1,478.12 / $1,666.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,232.43 / $1,636.89 / $2,275.86