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Michigan rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,461.14 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.83 / $1,461.14 / $1,461.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,393.32 / $6,295.63 / $8,576.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.66 / $1,631.66 / $2,962.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,065.54 / $1,330.71 / $2,353.09
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,169.38 / $4,933.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,169.38 / $1,298.34 / $1,884.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.78 / $1,005.70 / $1,494.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,906.00 / $4,645.00 / $6,327.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.14 / $1,556.03 / $2,126.83