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Tennessee rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,821.00 / $3,161.23 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,112.26 / $1,417.59 / $1,537.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,275.00 / $2,326.00 / $4,936.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,075.18 / $1,445.94 / $2,575.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,112.06 / $1,613.28 / $2,532.39
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $10,475.20 / $10,711.76
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,367.68 / $8,556.08 / $9,540.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.00 / $2,665.00 / $4,918.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,117.99 / $1,719.59 / $2,626.56