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Maine 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
$732.45 / $914.20 / $1,032.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$849.25 / $952.23 / $1,437.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.69 / $1,055.22 / $1,511.79
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$781.70 / $1,006.76 / $1,544.43
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.45 / $914.20 / $1,032.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$826.32 / $1,123.89 / $1,388.61