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Oklahoma 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
$1,000.00 / $2,630.27 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $794.33 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $977.24 / $1,174.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $3,388.44 / $10,232.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $851.14 / $5,248.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $5,754.40 / $10,715.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $776.25 / $1,122.02