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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
$1,281.28 / $4,722.42 / $8,031.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.45 / $1,281.28 / $1,664.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,826.00 / $4,945.58 / $13,227.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$700.50 / $1,408.58 / $1,671.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.01 / $1,113.79 / $2,242.23
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.29 / $1,159.06 / $1,159.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,944.00 / $10,417.00 / $16,323.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.89 / $1,090.47 / $2,174.54