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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
$4,241.22 / $10,431.19 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.24 / $648.24 / $3,741.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,732.29 / $13,189.77 / $24,760.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.21 / $1,067.40 / $1,423.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,304.95 / $1,621.68 / $2,169.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$686.28 / $1,231.66 / $8,632.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$926.41 / $1,640.05 / $5,240.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,304.95 / $1,741.91 / $4,791.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,116.75 / $1,536.37 / $2,156.60
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $1,211.00 / $1,736.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,091.79 / $1,599.60 / $1,982.88