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Missouri rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $4,897.79 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,318.26 / $2,238.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,786.30 / $10,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,412.54 / $2,290.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,174.90 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,584.89 / $2,570.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $1,949.84 / $10,715.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,819.70 / $8,511.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $2,818.38 / $10,471.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,584.89 / $2,630.27