go back

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
$707.95 / $870.96 / $1,584.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,071.52 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $954.99 / $1,548.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $954.99 / $1,412.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $912.01 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,023.29 / $1,548.82