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Virginia rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,309.66 / $4,771.00 / $9,539.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,087.06 / $1,309.66 / $1,428.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,604.05 / $10,127.70 / $14,105.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.51 / $1,347.20 / $1,847.68
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,322.96 / $1,481.72 / $2,579.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,159.15 / $1,547.42 / $2,869.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,091.17 / $1,309.40 / $1,614.93
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,235.18 / $1,607.31 / $2,228.10
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,444.00 / $1,609.00 / $2,677.94
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,135.84 / $1,546.57 / $2,764.67
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,135.84 / $1,546.57 / $2,764.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,547.00 / $3,130.00 / $5,226.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$992.73 / $1,505.08 / $2,494.56