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Missouri 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
$810.93 / $4,470.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.54 / $804.00 / $820.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $1,963.00 / $4,852.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$720.56 / $915.00 / $1,400.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.04 / $1,033.82 / $1,873.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$577.04 / $1,199.49 / $5,504.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.61 / $1,299.21 / $5,240.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,156.00 / $4,000.00 / $10,781.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.89 / $1,001.43 / $1,955.87