go back

West Virginia rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,174.90 / $2,187.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,479.11
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $1,949.84 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,621.81 / $7,079.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,288.25 / $2,041.74