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Maryland 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
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $2,238.72
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $741.31 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $2,630.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $933.25 / $1,995.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $741.31 / $1,230.27
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
$616.60 / $870.96 / $1,445.44
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $831.76 / $977.24