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Connecticut 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
$1,318.26 / $4,677.35 / $10,471.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $1,659.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,079.46 / $14,125.38 / $16,595.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,348.96 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,148.15 / $1,862.09
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,230.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $10,471.29 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $933.25 / $2,041.74