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South Carolina rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,402.50 / $3,178.92 / $16,467.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,123.42 / $1,402.50 / $1,797.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,070.33 / $1,693.00 / $2,976.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,206.58 / $1,618.35 / $3,008.06
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,123.42 / $1,561.20 / $2,546.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.60 / $1,083.46 / $1,789.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.00 / $6,107.00 / $8,818.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,134.33 / $1,704.75 / $2,966.52