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New York 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
$869.60 / $3,100.00 / $9,661.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.69 / $869.60 / $1,770.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,100.00 / $7,264.00 / $12,274.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.16 / $759.71 / $1,708.63
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,002.43 / $1,002.43 / $10,957.50
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,002.43 / $1,002.43 / $1,002.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$805.64 / $805.64 / $7,227.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$657.07 / $1,235.44 / $2,753.74
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $1,186.40 / $1,944.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$797.54 / $955.71 / $1,430.27
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.01 / $856.84 / $1,273.58
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $805.64 / $7,227.90
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$720.24 / $1,188.33 / $2,574.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,337.00 / $6,450.00 / $12,742.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.41 / $896.39 / $2,227.15
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$909.71 / $909.71 / $2,548.82
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.01 / $909.71 / $1,485.88