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Ohio rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,146.31 / $4,723.00 / $11,627.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,128.54 / $1,146.31 / $2,277.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,315.00 / $8,450.20 / $15,206.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$945.48 / $1,252.26 / $2,208.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,087.53 / $1,305.04 / $2,039.12
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,196.28 / $1,296.91 / $2,120.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$921.51 / $1,522.54 / $2,344.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,073.66 / $1,650.58 / $2,264.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.77 / $1,142.84 / $1,620.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,480.00 / $3,086.00 / $6,111.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.63 / $1,499.71 / $2,554.15