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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
$692.65 / $1,107.44 / $7,439.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.65 / $723.00 / $1,144.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$610.10 / $1,328.79 / $2,032.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$843.36 / $1,191.59 / $1,952.31
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.65 / $988.53 / $1,757.84
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.53 / $988.53 / $1,761.40
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $1,218.50 / $1,736.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,293.00 / $12,216.00 / $19,066.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.54 / $1,005.14 / $2,128.10
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $5,183.84 / $14,302.50
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,126.08 / $5,126.08 / $5,831.40