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Louisiana 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
$933.25 / $2,691.53 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $1,258.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $7,585.78 / $10,715.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $977.24 / $1,174.90
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $933.25 / $1,230.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $5,248.07 / $11,748.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $851.14 / $1,348.96