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North Carolina 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
$691.83 / $1,659.59 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $812.83 / $1,737.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,023.29 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,122.02 / $1,778.28
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,000.00 / $1,621.81
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $1,318.26 / $1,737.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $12,302.69 / $19,054.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $891.25 / $1,659.59
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $14,454.40 / $14,454.40
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $5,888.44