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Hawaii 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
$2,818.38 / $2,818.38 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $758.58 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $851.14 / $870.96
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,348.96 / $7,943.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $741.31 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $912.01 / $1,122.02
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $776.25 / $1,258.93