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Kentucky 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
$707.95 / $1,288.25 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $812.83 / $954.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $10,715.19 / $11,220.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $794.33 / $1,122.02
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $891.25 / $1,071.52
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $912.01 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,230.27 / $4,466.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $4,677.35 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $977.24 / $1,412.54