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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
$742.81 / $1,614.00 / $7,727.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.81 / $742.81 / $742.81
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.05 / $846.18 / $6,846.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.59 / $1,051.69 / $2,364.67
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$714.08 / $1,561.05 / $1,561.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,261.00 / $4,165.00 / $26,408.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.89 / $1,092.14 / $1,808.73