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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
$977.24 / $1,288.25 / $2,454.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $977.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $4,786.30 / $6,606.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $933.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $1,230.27 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $3,981.07 / $10,964.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $741.31 / $1,348.96