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Arkansas rates for HCPCS 50575

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertion of endopyelotomy stent)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$972.36 / $1,342.00 / $3,109.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$667.12 / $972.36 / $1,078.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,782.27 / $4,782.27 / $5,738.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.23 / $941.33 / $941.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,653.03 / $3,653.03 / $3,653.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$905.68 / $1,244.26 / $1,450.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,565.00 / $2,828.00 / $6,957.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.70 / $941.84 / $1,384.42