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Indiana 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
$794.33 / $2,344.23 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $724.44 / $1,380.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $19,952.62 / $27,542.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,047.13 / $1,621.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $707.95 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,148.15 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $891.25 / $1,548.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $9,549.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $831.76 / $1,380.38