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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
$977.24 / $3,019.95 / $9,120.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $831.76 / $2,238.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $7,762.47 / $13,803.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $741.31 / $1,778.28
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $10,964.78
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $1,202.26 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,202.26 / $3,235.94
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,230.27 / $2,398.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $870.96 / $1,258.93
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $1,023.29 / $1,479.11
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $954.99 / $1,548.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $5,888.44 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $794.33 / $2,137.96
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $912.01 / $2,570.40
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $912.01 / $2,290.87