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Washington, DC 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
$741.31 / $2,137.96 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $758.58 / $2,238.72
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $5,495.41 / $10,715.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $933.25 / $1,995.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $676.08 / $1,548.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $16,218.10 / $33,884.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $891.25 / $1,737.80