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Nebraska 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
$1,258.93 / $7,943.28 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $741.31 / $3,715.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $12,589.25 / $24,547.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,071.52 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,584.89 / $2,137.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,548.82 / $8,912.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,479.11 / $5,248.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,659.59 / $2,187.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,548.82
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
$6,309.57 / $7,079.46 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,380.38 / $1,778.28